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Full text of "The American hospital of the twentieth century : a treatise on the development of medical institutions, both in Europe and in America, since the beginning of the present century"

AMERICAN HOSPITAL 



;T::iKT}]ir:-i century 





53411000R 




NATIONAL LIBRARY OF MEDICINE 



SURGEON GENERAL'S OFFICE 

LIBRARY. 



Section 

W.D.S. G.O. 8—613 



THE 

AMERICAN HOSPITAL 



TWENTIETH CENTURY 



A treatise on the development of medical 
institutions, both in Europe and in America, 
since the beginning of the present century. 



EDWARD F. STEVENS, Architect 



Member of American Institute of Architects 
Member of Royal Architectural Institute of Canada 
Member of American Hospital Association 



/ 

REVISED EDITION 
ILLUSTRATED 



NEW YORK 
The Architectural Record Company 



OF THE 



By 



» < » 



1921 




I 



Copyright 1921 
by Architectural Record Co. 




©CI.A622194 
JUL 27 1921 



To 

WARREN LEVERNE BABCOCK, M. D. 

Superintendent of The Grace Hospital 
DETROIT, MICHIGAN, 

Whose encouragement and advice decided the 
writer of this book to devote his entire practice to 
institutions for the sick, 

This book is respectfully dedicated. 



THE AMERICAN HOSPITAL OF THE TWENTIETH CENTURY 



FOREWORD TO FIRST EDITION 

In visiting the hospitals of Europe, one finds on every hand splendid examples 
of hospital architecture. The administrators of these institutions take pride not 
only in laying before the foreign visitor for inspection the institution itself, but 
in providing him with carefully prepared plans and descriptions of the institution 
and its equipment. Everywhere one can obtain profusely illustrated books on the 
modern hospitals of the locality, books written and published by hospital admin- 
istrators, architects, and engineers. These books are most helpful to the native 
as well as to the foreigner. 

While visiting these foreign institutions, the writer has been asked repeatedly 
for the names of recent books on American hospitals. Such books are, alas, very 
few in number, and there are none commensurate with the rapid growth and 
development of the modern American hospital. 

It is in response to this demand that the writer has endeavored to collect 
plans and information concerning a few of the many good institutions recently 
finished or under construction, with the hope that interest in the publication of 
such works will grow and that this book will be only a forerunner of much 
more comprehensive treatises. It is not the writer's intention to criticise the plans 
of the institutions here shown, but to present them as various solutions of the 
great problems of housing and caring for the sick and to point out a few of the 
findings of his own experience in the planning of more than fourscore hospitals 
and institutions. The field is so broad that it is impossible more than to touch 
upon the various points. 

If frequent mention is made of hospitals in Europe, it is for the purpose 
of comparison, with the hope that the study and comparison may interest the 
reader, as it did the writer in collecting the data. 

The chapters on the Ward Unit, the Surgical Unit, the Medical Unit, and 
the Equipment are taken largely from papers by the writer which were read 
before the American Medical Association and the American Hospital Association. 

The chapters on Heating, Ventilation, Plumbing, and Landscape Work have 
been reviewed and suggestions given by prominent specialists in each line, for 
which advice the writer is much indebted. 

Edward F. Stevens. 

Boston, February, 1918. 



FOREWORD 



TO 

REVISED EDITION 

The expressed appreciation of friends and 
readers as to the helpfulness of this book has 
led the writer to feel that it might be counted 
a success. In the second edition, herewith 
presented, the original text has been thor- 
oughly revised, and much new material added, 
together with over one hundred and fifty new 
illustrations. 

Edward F. Stevens. 



Boston, June, 1921. 



THE AMERICAN HOSPITAL OF THE 
TWENTIETH CENTURY 



CONTENTS 



Page 



er I. 




1 


II. 


The Administration Department .... 


18 


III. 


The Ward Unit 


27 


IV. 




104 


V. 


The Medical Treatment Department 


119 


VI. 




126 


VII. 


The Children's Department ..... 


149 


VIII. 


The Department for Communicable Diseases 


170 


IX. 


The Psychopathic Department .... 


183 


X. 


The Tuberculosis Department .... 


200 


XI. 


The Laboratories. The Roentgen-ray Department . 


216 


XII. 


The Out-Patient Department. The Social Service 


Depart- 




ment ........ 


227 


XIII. 


The Small Hospital ...... 


243 


XIV. 


The Nurses' Residence ...... 


276 


XV. 


The Kitchen and Laundry ..... 


294 


XVI. 


Heating, Ventilation, Plumbing .... 


312 


XVII. 


Details of Construction and Finish 


327 


XVIII. 


Equipment ........ 


341 


XIX. 


Landscape Architecture as Applied to Hospitals 


348 


XX. 


Remodeling a House for a Hospital 


358 


Appendix. 


War Hospitals . . 


366 



(General 3nbex 

-• 



Page 

Accessibility of Service 27 

Administration Buildings 18 

American Memorial Hospital at 

Rheims 89 

Amphitheatre Operating Room Obso- 
lete 104 

Artificial Illumination 332 

Barmbeck III Hospital 7, 37 

Barre City Hospital 248 

Baths 31, 119 

Beds, Hospital 341 

Bedside Table 341 

Bethesda Hospital 146 

Bispebjerg Hospital 5, 40 

Boston Consumptives' Hospital at Mat- 

tapan 202 

Bridgeport Hospital..54. 117, 130, 156. 281, 310 

Brigham Hospital, Peter Bent.... 7, 20, 41 

Buffalo General Hospital 47, 114, 226 

Cabinets, Built-in 117, 345 

Cable Memorial Hospital, Benjamin 

Stickney 252 

Call System for Nurses 336 

Call System for Staff 337 

Central New England Sanatorium 215 

Chart Holders 339 

Chicago Lying-in Hospital 140 

Children's Department 149 

Children's Hospital, Denver 162 

Children's Hospital, Halifax 162, 182 

Children's Hospital, Philadelphia 233 

Choate Memorial Hospital, Charles 358 

Church Hospital 89 

Cincinnati General Hospital. ..8, 43, 114, 297 

Closets, Clothes 329 

Closets, Linen 329 

Closets, Medicine 329 

Clothing. Patients' 31, 342 

Comfort of Patients 27 

Communicable Diseases, Department for 170 

Construction and Finish, Details of 327 

Contagious Hospital, Principles of 

Planning 173 

Cook County Hospital, Psychopathic 

Building 199 

Creche or Nursery 127 

Day Rooms 29 

Deaconess Hospital at Concord 246 

Decorations. Importance of 18 

Decorations, Wall 150 

Delivery Rooms 36, 126 

Diet Kitchens 301 

Dining Rooms 307 

Disinfecting Room 347 

Doctors' Calling System 337 

Doors 328 

Drinking Fountains 33 

East New York Hospital 236 

Equipment 341 



Page 

Equipment, Laundry 310 

European Hospitals, Influence of 3 

Faulkner Hospital 145 

Floors 109, 331 

Flowers, Room for 33 

Ford Hospital, Henry 47 

Furniture, Type of 18 

Galloway Memorial Hospital 54 

Geisinger Memorial Hospital, George F. 

47, 114 

General Hospitals 54 

German Hospital 54 

Good Samaritan Hospital, Cincinnati... 17 

Good Samaritan Hospital, Sandusky.... 260 

Grace Hospital 112 

Greenville Hospital 256 

Growth of Hospitals 1 

Hamot Hospital 47, 116 

Handles, Hook 330 

Hardware 329 

Harper Hospital 51 

Heating, Ventilating and Plumbing.... 312 

Heywood Memorial Hospital 162 

Historical 1 

Hospital Beds 341 

Hospital Sites 1 

Hurley Hospital 182 

Illinois Central Railroad Hospital 87 

Illumination, Artificial 332 

Incinerator 346 

Incubator for Infants 151 

Industrial First Aid Buildings 241 

Information Desk 18 

Jackson County Isolation Hospital 181 

King's College Hospital 4 

Kings County Hospital 291 

Kingston Avenue Hospital 179 

Kitchen and Laundry, The 294 

Kitchen Planned Around Equipment... 294 

Kitchen Utensils 307 

Laboratories 216 

Laboratory in Operating Suite 112 

Landscape Architecture 348 

Lane Home for Invalid Children, Har- 
riet (Johns Hopkins Hospital) 154 

Laundry, The 308 

Laundry Equipment 310 

Loomis Sanatorium, Olivia Cottage.... 215 

Macon Hospital 75, 236 

Mansfield General Hospital 81 

Mason Hospital 260 

Massachusetts General Hospital 19 

Massachusetts Homeopathic Hospital.. 181 

Massachusetts Psychopathic Hospital.. 193 

Maternity Department 126 

Mattresses 342 



INDEX 



Page 



Mayo Clinic 221, 239 

Meadville Hospital 130 

Medical Treatment Department 119 

Medicine Closets 31 

Alelrose Hospital 256 

Memorial Buildings 17, 18 

Munich-Schwabing Hospital 7, 40, 122 

New England Deaconess Hospital at 

Concord 246 

New Rochelle Hospital 311 

Newton Hospital 127 

New York City Hospital at Blackwell's 

Island 116 

Noises 33 

Notre Dame Hospital 11, 20, 61, US 

Nova Scotia Sanatorium 215 

Nurses' Call System 336 

Nurses' Residence, The 276 

Nurses' Stations 338 

Nurses' Work Room 112 

Observation Wards 149 

Occupational Therapy 124 

Ohio Valley General Hospital, 

21, 70, 113, 140, 181, 298 
Operating Rooms, Artificial Illumination 

of 334 

Operating Rooms, Color of Walls... 109, 335 

Operating Rooms, Size and Number. . . . 104 

Operating Rooms, Heating of 105 

Operating Rooms, Lighting of 106 

Operating Rooms without Skylight 106 

Orientation 2 

Orthopedic Service 150 

Ottawa Civic Hospital, 

15, 20, 23, 56, 115, 145, 241, 290, 291, 297, 310 

Out-Patient Department 227 

Parker Hospital. Willard 179 

Pasteur Hospital 170 

Patients' Clothing, Care of 31, 342 

Phipps Psychiatric Clinic, Johns Hop- 
kins Hospital 198 

Play Room 149 

Plumbing 312 

Plumbing, Hospital 315 

Pneumatic Chamber 122 

Psychiatric Clinic at Munich 183 

Psychiatric Clinic at Utrecht 186 

Psychopathic Department 183 

"Quiet" Rooms 28 

Quincy City Hospital 113 

Reheaters 117 

Reid Memorial Hospital 70, 116 

Remodeling a House for Hospital 358 

Remodeled Operating Department 116 

Rhode Island General Hospital 116 

Rigs Hospital 37 



Page 

Robinson Memorial, Jennie M. (Massa- 



chusetts Homeopathic Hospital) .. 145, 241 

Roentgen-ray Department 222 

Roof Wards 28 

Royal Victoria Hospital 8, 87, 221, 241 

Ruptured and Crippled, Hospital for. ... 159 

St. Georg Hospital 112 

St. Joseph's Hospital 89 

St. Luke's Hospital, Jacksonville. .53, 179, 290 

St. Luke's Hospital, New Bedford 140 

Salem Hospital 70 

Scrub-up Sinks 112 

Sea View Hospital 213 

Serving Kitchens, Principles of Plan- 
ning 304 

Serving Kitchens 29, 301 

Sick Children, Hospital for.. 154, 181. 239, 281 

Sink Room 346 

Sites, Hospital 1 

Small Hospital, The 243 

Social Service Department 242 

Soldiers' and Sailors' Memorial Hospital 260 

Special Nurses, Room for 33 

Sterilizers 342 

Sterilizing Room 112 

Surgical Department 104 

Surgical Dressing Room 33 

Table, Bedside 341 

Talitha Cumi Maternity Home 128 

Tennessee Coal, Iron and Railroad 

Company's Hospital 51 

Thomas Hospital, Josiah B 257 

Thomson Hospital, Wallace 270 

Tuberculosis Department 200 

Utilities, Proportion of 27 

Vacuum Cleaners 338 

Ventilation 312 

Victoria General Hospital ... 47, 182, 292, 298 

Waiting Space for Visitors 18 

Walls ..328, 335 

Wall Decorations 150 

War Hospitals 366 

Ward Unit 27 

Ward Units, American 41 

Ward Units, European 37 

Wards, Roof 28 

Water Bed 122 

Wesson Maternity Hospital 145 

Western Infirmary 233 

Wheel Chair, Room for 31 

Wide Windows Desirable 27 

Williams' Private Sanatorium 243 

Windows 327 

Worcester City Hospital 159 

Yonkers Homeopathic Hospital 260 

Youngstown Hospital 53, 113 



3nbex to Musitrattons 



Page 

American Memorial Hospital at Rheims. 

Exterior 100 

Floor Plans 97, 98, 99 

Army Hospitals. 

General Plans 367, 368, 369, 371, 376 

Ward Plans 367, 370, 373, 374, 

375, 376, 377, 379 

Autopsy Table 324 

Autopsy Table. Marble 325 

Barre City Hospital. 

Exterior 250 

Floor Plans 249, 250 

Operating Room 118 

Bath, Admitting 318 

Bath, Baby 319 

Barmbeck Hospital, Plot Plan 7 

Beds, Hospital 341, 342, 343, 344 

Bedside Tables 345 

Bethesda Hospital, Maternity Building, 

Floor Plans 141, 142, 143 

Beverly Hospital, Plot Plan 355 

Bispebjerg Hospital. 

Exterior 30 

Interior of Ward 30 

Kitchen 295 

Operating Room 31 

Plot Plan 5 

Ward Unit 29 

Boston Consumptives' Hospital, Floor 

Plans ....207 

Bridgeport Hospital — Birdseye View. 14 
Plot Plan 13 

Bridgeport Hospital. Maternity Pavilion. 

Children's Day Room 157 

Children's Ward 156 

Creche 129 

Diet Kitchen 303 

Exterior 58 

Floor Plans 56, 57 

Operating Room 130 

Private Room 59 

Ward 59 

Bridgeport Hospital, Nurses' Residence. 

Exterior 278, 279 

Floor Plans 277 

Interior Views 279, 280, 281 

Bridgeport Hospital, Operating De- 
partment. 

Built-in Cases 115 

Floor Plan 114 

Major Operating Room 116 

Bridgeport Hospital, Service Building, 

Floor Plan 308 

Brigham Hospital, Peter Bent. 

Airing Balcony 36 

Entrance Rotunda 21 

General View 10 

Interior of Wards 35 

Plot Plan 9 

Ward Unit 34 

Brockton Hospital, Ambulance Entrance 19 



Page 

Buffalo General Hospital, Private Pa- 
vilion. 

Exterior 43 

Floor Plans 42 

Roentgen-ray Department, Plan 224 

Cable Memorial Hospital, Benjamin 
Stickney. 

Day Room 28 

Entrance Hall 20 

Exterior 253, 254 

Floor Plans 251, 252 

Plot Plan 356 

Canton's Hospital School 316 

Central New England Sanatorium. 

Floor Plans 208, 209, 210 

Plot Plan 211 

Chart Cases 339, 340 

Chicago Lying-in Hospital, Floor Plans. 

132, 133 

Children's Hospital, Denver. 

Exterior 162 

Floor Plans 163, 164, 165 

Children's Hospital, Halifax. 

Floor Plans 166, 167 

Children's Hospital, Munich, Interior 

View 169 

Children's Hospital, Philadelphia 

Out-Patient Department 231 

Choate Memorial Hospital. 

Exterior 359, 360 

Floor Plans.,358, 359, 360, 361, 362, 363, 364 
Surgeons' Scrub-up 324 

Cincinnati General Hospital, Plot Plan. 11 

Cincinnati General Hospital, Kitchen 
Building. 

Exterior 300 

Floor Plan 299 

Interior View 300 

Serving Kitchen 305 

Cincinnati General Hospital, Operating 
Building. 

Floor Plans 110, 111 

Cincinnati General Hospital, Ward 
Buildings. 

Exterior 38 

Interior of Ward 37 

Receiving Ward 26 

Ward Unit 36 

Clothes Closet Detail 315 

Clothing Lockers 346 

Cook County Hospital, Psychopathic 
Building. 

Floor Plans 193, 194 

Door Detail Connecting Baths 334 

Door Finish Details 328, 329 

Drinking Fountain 326 

East New York Hospital, Out-Patient 
Department. 
Floor Plans 235, 236 



INDEX 



Page 

Entrance to New England Deaconess 
Hospital 25 

Factory First-Aid Building. 

Exterior 240 

Floor Plans 241 

Farlsrhue State Hospital, Kitchen De- 
tail 297 

Faulkner Hospital, Maternity Ward 
Building. 

Floor Plans 138, 139, 140 

Floor Drains 324 

Fluoroscope 225 

Food Lifts 306 

Food Truck, Open 306 

Food Truck, Heated 307 

Footstools 345 

Ford Hospital, Henry, Ward and Oper- 
ating Building 39 

Forsyth Dental Infirmary, Wall Deco- 
ration 151 

Galloway Memorial Hospital, Second 
Floor Plan 60 

Geisinger Memorial Hospital, George F. 

Exterior 48 

Floor Plans 46, 47 

German Hospital, Chicago, Floor Plans, 

61, 62 

Good Samaritan Hospital, Cincinnati. 

Exterior 16 

Typical Floor Plan 15 

Good Samaritan Hospital, Sandusky, 

Floor Plans 269, 270 

Grace Hospital, Operating Department 

Plan 106 

Greenville Hospital, Floor Plans 255 

Hamot Hospital, Private Pavilion. 

Exterior 41 

Floor Plans 40 

Harper Hospital, Hudson Memorial, 

Floor Plans 51 

Haynes Home for Nurses, J. Man- 
chester. Floor Plans 292 

Heating. 

Chart 314 

Direct-indirect Radiators 313 

Method of Heating in General Hos- 
pital at Vienna 313 

Help's Building, Plans 293 

Heywood Memorial Hospital. 

Floor Plans 144, 145 

Plot Plan 355 

Hospital Beds 341, 342, 343, 344 

Hospital Entrance 18 

Hook Handle 337 

Hurley Hospital, Isolation Building. 

Exterior 182 

Floor Plans 181 

Illinois Central Railroad Hospital, Floor 

Plans 90, 91 

Jackson County Isolation Hospital, 

Floor Plans 177. 178 

Jacksonville City Proposed Tuberculosis 
Unit. 

Floor Plans 201, 202 



Page 

Johns Hopkins Hospital, Harriet Lane 
Home for Invalid Children, Floor 

Plans 152, 153 

Johns Hopkins Hospital, Phipps Psychi- 
atric Clinic. 

Exterior 198 

Interior View 124 

Floor Plans 195, 196, 197 

Kettles, Tilting 297 

King's College Hospital, Plot Plan ...... 4 

Kingston Avenue Hospital, Isolation 

Pavilion, Floor Plans 171 

Lane Home for Invalid Children, Har- 
riet, Johns Hopkins Hospital, Floor 

Plans 152, 153 

Lavatories 320 

Lighting Fixture Details 337, 338 

Lighting Fixture, Ward, Detail 337 

Linen Closet Detail 336 

Lockers, Clothing 346 

Loomis Sanatorium. 

Exterior 214 

Floor Plans 213 

Macon Hospital. 

Floor Plans 85, 86, 87 

Out-Patient Department Plan 234 

Mansfield General Hospital, Floor Plans, 

88, 89 

Mason Hospital. 

Exterior 265 

Floor Plans 263, 264 

Massachusetts General Hospital. 

Administration Building, Exterior and 

Floor Plans 22, 23 

Nurses' Residence, Floor Plans, 

282, 283, 284 

Operating Department 105 

Original Building 18 

Zander Room 123 

Massachusetts Homeopathic Hospital. 
Haynes Memorial Building. Floor 

Plans 176 

Jennie B. Robinson Memorial, Floor 

Plans 136, 137 

Massachusetts Psychopatic Hospital. 

Exterior 189 

Floor Plans 190, 191. 192 

Massachusetts State Infirmary, Nurses' 
Residence. 

Floor Plans 286, 287, 288 

Mayo Clinic, Floor Plans.. 220, 221, 222, 223 
Meadville City Hospital, Maternity De- 
partment. 

Floor Plans 128 

Medicine Closet Detail 335 

Melrose Hospital. 

Children's Ward 155 

Exterior 259, 260 

Floor Plans 257, 258 259 

Plot Plan 256 

Private Room 261 

Morse Hospital, Leonard, Nurses' Home, 

Plans 291 

Munich-Schwabing Hospital. 

Dissecting Room 217 



INDEX 



Page 

Medical Treatment Department, Plan. 120 
Pathological Building, Floor Plans.. 

216, 217 

Pathological Department, Animal 

Building 218 

Plot Plan 8 

Pneumatic Chamber 121 

Sand Bath 122 

Ward Unit 32 

Water Bed 122 

New England Deaconess Hospital, Con- 
cord. 

Exterior 248 

Floor Plans 247 

Newton Hospital. 

Grounds 350, 351, 352, 353 

Plot Plan 350 

New Rochelle Hospital, Service Build- 
ing, Plan 311 

New York City Hospital, Operating De- 
partment, Plan 113 

Notre Dame Hospital, Floor Plans, 

72, 73, 74 

Nova Scotia Sanatorium. 

Exterior 212 

Floor Plan 212 

Nurses' Station, Plan 339 

Occupational Department in Hospitals, 

Interior 125 

Old English Hospital, Diagram of 2 

Ohio Valley General Hospital. 

Airing Balcony 84 

Exterior 83 

Floor Plans 81, 82, 83 

Isolation Department 175 

Kitchen 302 

Operating Room 109 

Rear View 84 

Roentgen-ray Department 224 

Serving Kitchen 304 

Surgeons' Scrub-up 323 

Orientation Diagram 3 

Ottawa Civic Hospital. 

Block Plan 12 

Exterior 71 

Floor Plans 63, 64, 65, 66, 67, 68, 69 

Section 70 

Ottawa Civic Hospital, Laundry, Floor 

Plans , 310 

Ottawa Civic Hospital, Nurses' Resi- 
dence, Floor Plans 285 

Out-Patient Department for New York 

City, Floor Plans 232, 233 

Out-Patient Department, Typical Build- 
ing Plans 228, 229, 230 

Parker Hospital, Willard, Measles Pa- 
vilion, Floor Plans 171 

Pasteur Hospital, Floor Plan 170 

Phipps Psychiatric Clinic, Johns Hopkins 
Hospital. 

Exterior 198 

Interior View 124 

Floor Plans 195, 196. 197 

Plumbing Fixture Details 321, 322, 323 



Page 

Pneumatic Chamber, Plan and Section.. 121 
Psychiatric Clinic, Munich, Floor Plans, 

184, 185 

Psychiatric Clinic, Utrecht. 

Floor Plans 186, 187, 188 

Interior Views 188 

Quincy City Hospital, Operating Build- 
ing. 

First Floor Plan 108 

Operating Room 108 

Surgeons' Scrub-up 317 

Reid Memorial Hospital, Floor Plans. .75, 76 

Revolving Airing Balcony 200 

Rhode Island Hospital, Operating De- 
partment, Plan 112 

Rigs Hospital. 

Ward Unit 29 

Kitchen 296 

Royal Victoria Hospital. 

Distant View Frontispiece 

Plot Plan 12 

Royal Victoria Hospital, Ross Pavilion. 

Entrance Gates 19 

Entrance Hall 21 

Exterior Views 95, 96 

Floor Plans 92, 93, 94 

Kitchen . 302 

Medical Treatment Department, Plan 123 
Plan and Section Through Operating 

Room 317 

Plot Plan 21 

Serving Kitchen, Interior and Plan. 303, 304 

Royal Victoria Hospital, Out-Patient 
Department. 

Floor Plans 238, 239 

Metabolism Clinic 223 

Ruptured and Crippled, Hospital for Re- 
lief of. 

Floor Plans 159, 160, 161 

Salem Hospital. 

Floor Plans 78, 79, 80 

Plot Plan. 77 

San Francisco Hospital, Medical 

Treatment Department 124 

Sea View Hospital. 

Dining Hall Building 204 

Group Building, Floor Plans 204, 205 

Plot Plan 203 

Ward Building, Floor Plans 206 

Serving Kitchen Cabinet 336 

Sick Children, Hospital for. 

Exterior 153 

Isolation Department 175 

Laundry 309 

Nurses' Residence, Floor Plans 276 

Out-Patient Department, Floor Plan. 237 

Pasteurizing Room 155 

Typical Floor Plan 154 

Sink Room Interiors 347 

Sink for Isolation Wards 324 

Sink Room 347 

Slop Sink 318 



1 NDEX 



St. Georg Hospital. 

Dissecting Table 220 

Operating Unit 105 

Pathological Building, Floor Plans... 219 

St. Joseph's Hospital. 

Chapel 102 

Exterior 103 

Floor Plans 101, 102 

St. Luke's Hospital, Jacksonville. 

Administration and Operating Build- 
ing, Exterior and Floor Plans 24 

Admitting Bath 318 

Connecting Corridor and Public Ward, 

Exterior 55 

Isolation Pavilion, Exterior 173 

Floor Plans 172 

Interior Views ... . 174 

Laundry, Plan 309 

Nurses' Residence, Exterior 289 

Floor Plans 289 

Sleeping Porch. . . 290 

Plot Plan 16 

Private Pavilion, Exterior 53 

Floor Plans 52 

Public Ward Unit 54 

St. Luke's Hospital, New Bedford. 

Maternity Department, Floor Plans.. 131 

Serving Kitchen 305 

St. Thomas' Hospital, London, Chil- 
dren's Ward 150 

Soldiers' and Sailors' Memorial Hospital. 

Exterior 272 

Floor Plans 271, 272 

State Hospital, Farlsruhe, Kitchen De- 
tail 297 

Sterilizers 347 

Surgeons' Scrub-up Bowls 317, 323. 324 

Talitha Cumi Maternity Home. 

Floor Plans 127 

Plot Plan 354 

Tennessee Coal, Iron and Railroad 
Company's Hospital. 

Exterior 50 

Typical Floor Plan 49 



Page 

Thomas Hospital, Josiah B. 

Exterior 262 

Floor Plans .261, 262 

Thomson Hospital, Wallace. 

Exterior 275 

Floor Plans 273, 274 

Tilting Kettles ' 297 

Treatment Booth Detail 337 

Vent Flue Details 314 

Victoria General Hospital. 

Isolation Department, Plan 179 

Plot Plan 13 

Private Pavilion, Floor Plans 44, 45 

Service Building, Floor Plans 301 

Virchow Hospital. 

Kitchen 298 

Plot Plan 6 

View of Grounds 349 

Ward Unit 33 

Ward Lighting Fixture, Detail 337 

Wash Basin 320 

Wesson Maternity Hospital, Floor 

Plans 134, 135 

Western Infirmary, Glasgow, Out-Patient 

Plan 231 

Wilhelmina Hospital, Children's Depart- 
ment. 

Interior Views 147, 168 

Williams' Private Sanatorium. 

Exterior 246 

Floor Plans 244, 245 

Operating Room 117 

Window Detail 333 

Window Finish Details 330 

Window, Full View, Details 331, 332 

Worcester City Hospital, Children's 
Building. 

Exterior 158 

Floor Plan 158 

Yonkers Homeopathic Hospital 

Exterior 268 

Floor Plans 266, 267 

Youngstown Hospital. 

Tod Wing, Floor Plans 55 

Operating Building, Floor Plans 107 

Out-Patient Department 239 



THE AMERICAN HOSPITAL OF THE 
TWENTIETH CENTURY 

CHAPTER I. 

in General 



Historical. It would be vastly interest- 
ing to trace the evolution of hospital 
building and equipment from the crude 
structures of ancient times designed to 
house the sick to the comprehensive hos- 
pital of today, and to show how architec- 
ture and equipment have advanced stride 
for stride with medical and surgical prog- 
ress ; but in these days of vivid and insist- 
ent research and accomplishment there 
is no time for comparative speculation 
or historical review. All our energies 
are needed to keep pace with the newly 
devised methods which are constantly be- 
ing put in practice and to facilitate these 
achievements by proper housing and 
equipment. Hospital building, since the 
beginning of the twentieth century, has 
increased enormously. 

In the year 1911 the number of hos- 
pitals in the United States was said to 
be 2,500. In 1914 it was given as 7,000. 
In 1918 the number of hospitals was re- 
ported as being 7,158, with about 680,000 
beds. Even with this vast number only 
about * "twelve per cent, of the sick peo- 
ple in this country who are ill enough to 
need a doctor are cared for in hospitals." 

The line of advance has been influenced 
not only by the medical men and the nurs- 
ing force, but by the social welfare 
worker, the hospital commission, the so- 

*Editorial Modern Hospital, Vol. VIII, No. 1. 



ciety to suppress tuberculosis, and the 
public at large ; for the people are realiz- 
ing that the hospital is built to benefit 
humanity and not to afford a place in 
which to die. "All hope abandon ye who 
enter here" no longer is the appropriate 
inscription for the hospital gate. But 
this advance has been by gradual steps — 
an improved ward unit here ; better meth- 
ods of service there; building up thus 
by experimental work and research a 
standard to meet the needs as they ap- 
pear, and with the ever-increasing feel- 
ing that the welfare of the patient is 
of more importance than the zeal for 
science. 

Hospital Sites. Before taking up the 
subject of the planning of the hospital 
itself, we must consider the very impor- 
tant subject of the site. Attractive loca- 
tions for public buildings or even for resi- 
dences are rarely suitable for hospitals 

The improvement of the patient, which 
is the fundamental purpose of the insti- 
tution, depends in large measure on its 
situation and environment — the contour 
of the land, the surrounding country, the 
aspect, the accessibility for friends of the 
patient and for visiting physicians, re- 
moteness from disturbing influences, a 
site of sufficient size to insure privacy, 
are all contributory elements for the 
process of recovery. 



2 



THE AMERICAN HOSPITAL 




FIG. 1. DIAGRAM OF AN OLD ENGLISH 
HOSPITAL. 



A southern exposure is always desir- 
able, with the land sloping toward the 
south. If in the country, it is still more 
advantageous if the north is protected by 
evergreen trees. 

Enough land should be provided to 
allow for growth. In building even the 
first portion, the future should be con- 
sidered and the plans for the develop- 
ment of the entire institution studied and 
worked out so that the structures may 
be grouped to the best advantage. What- 
ever portion is built, it should be done 
with reference to the completed whole. 
Oftentimes the central or administration 
building is all that can be managed in the 
beginning, and in this must be disposed 
temporarily all the departments. 

If the site is in the city, the same care 
in selection should be exercised. Smoke 
from adjoining chimneys, noise from 
nearby railroads, and proximity to a 
noisy thoroughfare or factory are men- 
aces to be considered. 

The suggestions for treating the 
grounds of an institution will be taken 
up in the chapter on Landscape Archi- 
tecture. 

Orientation. The orientation of a hos- 
pital, i. e., its setting with reference to 
light and sunshine, should be very care- 
fully studied. The building should be 
placed with due regard not only to sun- 
light, which is as important a factor in 
a hospital as any one thing, but also with 
reference to the prevailing winds. 

The early hospitals were congested 
groups of buildings, with little or no pro- 
vision for light and air. (See diagram 
1.) The grounds surrounding the hos- 



pital building should be flooded with sun- 
light, as well as the rooms occupied by 
patients, since cold and soggy ground will 
react unfavorably on buildings near it. 
Neither is a pavilion surrounding a court- 
yard good hospital planning, nor a U- 
shaped building, if the open side of the 
U is toward the north. By reference to 
the diagram (Fig. 2) taken from Atkin- 
son, it will be seen that a rectangular 
building placed with its main axis run- 
ning north and south will have a very 
small portion in shadow during the hours 
of daylight, while if the same building be 
placed with an east and west axis the 
entire north side will be in shadow. L 
and H forms of buildings, placed at vary- 
ing angles to the north, will receive more 
or less sunlight according to the angles 
they face. 

In planning the interior of the building, 
the portion which receives no sun at all 
during the day should be used, so far as 
possible, for utilities, staircases, and 
rooms not requiring sunlight, leaving for 
patients' rooms the sides which receive 
sunlight some portion of the day. 

Buildings. The building or buildings 
should be simple in style and designed to 
make a pleasing impression upon the pa- 
tients with the entrance speaking a wel- 
come. The motto suggested for the 
Virchow, in Berlin, might well be placed 
over the entrance of many another hos- 
pital — "While treating the disease, do not 
forget to treat the man." 

Hospital planning demands the same 
careful thought that is the foundation of 
any modern successful business enter- 
prise. It is essential in the shoe factory, 
the paper mill, or the business establish- 
ment to so plan that the raw materials 
may be assembled and the finished prod- 
uct delivered with the fewest possible 
intervening motions. In the hospital 
the patient, the food and the treat- 
ment may be termed the raw material. 
Whatever conduces to recovery, the con- 
valescent being the finished product, is 
of business importance in the hospital. 
The care, the comfort, the convenience 
and the food, together with the treatment, 
are the processes of manufacture. The 
hospital planner must seek to eliminate 



OF THE TWENTIETH CENTURY 



3 









WITHOUT JTJMLl G HT FC£.->1 



3A.M T* -4- P, f 



■i 
■i 



FIG. 2. ORIENTATION DIAGRAM (ATKINSON). 



here all lost motion or unnecessary work. 

In the factory the saving of time in any 
of the processes adds to the annual prod- 
uct, and in the hospital, likewise, care- 
ful scientific nursing, freedom from dis- 
turbing elements and everything that can 
help early convalescence, add to the effi- 
ciency of the institution. With the de- 
mands for accommodations that are made 
in these days, any factors that will in- 
crease the percentage of hospital capacity 
will be truly valuable. Location is here 
most important, an environment that will 
be an uplift to the patient; an outlook 
that while distant from industries may 
still remind the patient that he is a part 
of the world's life and activity; sunlight 
and ventilation and the modern fresh air 
balcony ; these items and many others are 
factors toward increased hospital capac- 
ity. Internal disturbances should be 
avoided by planning the noisy rooms at 
a distance from the wards, and there are 
many important relations of the utilities 
to be considered, a single example of 



which may be the illumination in such a 
manner as to avoid eye-strain. 

Rooms should be used as originally in- 
tended, if it is at all possible. Failure to 
do this is sometimes responsible for the 
inconveniences which occasion criticism. 

Influence of European Hospitals. The 
good influence of European hospitals is 
shown in many of our modern American 
institutions. While we would not con- 
sider duplicating any one European in- 
stitution, we do receive from them valu- 
able suggestions for the solution of many 
a perplexing hospital problem. The gen- 
eral relation of one department to an- 
other, the method of preparing and serv- 
ing food, the housing and treatment of 
patients, the orientation and environ- 
ment, and the proportion of sunlight and 
shadow are some of the things upon 
which we may receive enlightenment. 
The hospital which would be perfect and 
which would fulfill the climatic conditions 
of southern France, however, would be 
entirelv unsuitable in our northern states. 



4 



THE AMERICAN HOSPITAL 



If we can put the European hospital 
on our dissecting table and remove the 
part we cannot use, we will still have a 
pretty good portion of the body left. By 
this metaphor I do not assume that hos- 
pital architecture is a dead subject — far 
from it. It is very much alive. Only 
last week our medical co-worker asked to 
have provision made for a patient in a 
warm, closed room, with hot baths ; yes- 
terday, the same patient was to be kept 
in the open air ; today, ice baths are pre- 
scribed ; and we must study the clinics 
very closely to find out what will be 
wanted tomorrow, for the hospital archi- 
tect must meet the latest demand. 

In one foreign institution we may find 
the ideal ward unit; in another, a service 
building of peculiar fitness ; and in still 
another, the perfect floor (although the 
ideal hospital floor does not seem to have 
been discovered yet). One institution 
will have an ideal operating or medical 



department, while in others the architects 
will have solved new problems in detail 
and equipment. 

The twentieth century hospital, 
whether built in Spain, Russia, or the 
United States, has one common condi- 
tion in its program — that is, to give the 
patient the best chance for recovery. 
If a more thorough study of sanitation, 
ventilation, nursing, disturbing elements, 
orientation, and environment, one or all, 
will help us to design buildings that 
hasten convalescence and produce the de- 
sired results, then that information must 
be obtained ; and, if necessary, we should 
be willing to circle the globe for it. 

Some European Hospitals. A few ex- 
amples of European hospitals will show 
some of the features which have inter- 
ested the writer in his study of the sub- 
ject. 

The new King's College Hospital, at 
Denmark Hill, London, is accepted as one 



THE NEW KING'S COLLEGE HOSPITAL BLOCK PLAN. 

A Medical Ward Block (Two Floor.). G Three Operating and one Clinical Theatre. 0 Medical School and Pathological Dept. 

B ., (Three Floor.). H Bathing Establishment. P Mortuary. 

C SurjycsJ Ward Block (Two Floors,. J Casualty Department. Q Isolation Block. 

D „ (Throe Floors). K Out-Patient Department. R .. .. Admunsto. 

E Clinical Theatre. L Administration Block. V Chapel. 

F Gyn. Op. PM. and Clinical Theatre. M & N Special Wards. 




FIG. 3. PLOT PLAN, KING'S COLLEGE HOSPITAL, LONDON, ENGLAND. 



OF THE TWENTIETH CENTURY 



5 



I LOT VUN 

DUPLDLtUG rtQ/PITAL 





j— xn Sic*. WAfcoj 1 

Xm-OTOptUkTI^ & fc>tXT<XK 
ZS-WU°J-ATI«^ 

(5 P°IYCUN 



C &MHS 
D.G.H l°DGfclL 



KlTCKtM 
U.UNPRY 




MCHITtCT 



FIG. 4. PLOT PLAN, BISPEBJERG HOSPITAL, COPENHAGEN, DENMARK. 



of the best English hospitals, and is in 
very many ways ideal. Its general plan 
is shown in Fig. 3. It occupies a block 
of ground in a crowded section of South 
London. Its present capacity is 600 pa- 
tients. 

The Bispebjerg Hospital, Copenhagen, 
Denmark (Fig. 4), designed by Professor 
Martin Nyrop, has an ideal site contain- 
ing fifty acres. It is located on slightly 
rising ground, and advantage has been 
taken of the natural contours to produce 
terraces and excellent landscape effects. 
The design of the group is simple and 
dignified. There are forty-six buildings, 
two or three stories high. These build- 
ings, while isolated above ground, are all 
connected by wide, well-lighted, under- 
ground corridors. The bath-house, while 



far removed from the ward buildings, 
serves for out patient clinics as well as for 
hospital patients. The grounds are laid 
out with special care for the comfort of 
the patients, with arbors, benches, and 
fountains. 

Perhaps the most familiar of the mod- 
ern hospitals is the Virchow (Fig. 5) at 
Berlin. This was built by Architect 
Ludwig Hoffmann in 1907, and is of the 
pure pavilion plan. It has a capacity of 
two thousand beds. With the exception 
of two ward units connected with the 
surgical or operating buildings and the 
administrative group, the buildings are 
all isolated and are of one story so far as 
the patients are concerned. Owing to the 
ease with which the patients can be taken 
from the buildings, the beautifully laid- 



0 



THE AMERICAN HOSPITAL 




FIG. 5. PLOT PLAN, RUDOLPH VIRCHOW HOSPITAL, BERLIN, GERMANY. 



out grounds and parks, with their walks third day for the sole use of the staff, 

and drives, become the ideal place for and every third day for the sole use of 

convalescents. One of the rules of these the nurses. 

parks is that on every third day they are The surgical group, on the left of the 

for the sole use of the patients, every main axis, is connected with the operat- 



OF THE TWENTIETH CENTURY 



7 



ing building, while the medical group has 
the bath-house occupying the same 
strategic position. The isolation group 
occupies a portion of the extensive 
grounds on the south, and the service 
buildings on the north. 

The ward pavilions, of which there are 
twenty practically alike, consist of two 
twenty-bed wards, with service at the 
center and at the ends, and with room 
for attendants in the second story of the 
central portion. 

The floors of the wards are elevated 
but little above the ground, giving a 
ready entrance for the patients and for 



church. On the surgical side, three of the 
pavilions are connected by corridors, 
while the fourth is isolated. All other 
buildings throughout the group are 
isolated. 

One of the most modern and complete 
hospitals in Germany is Munich-Schwa- 
bing (Fig. 7). In this building Archi- 
tect Richard Schachner has embodied the 
best of German planning and coupled 
with it the most valuable of American 
ideas. While he has separate pavilions, 
he also has everywhere connecting corri- 
dors above ground, except to the con- 
tagious and special treatment buildings, 




FIG. 6. PLOT PLAN, BARMBECK HOSPITAL, HAMBURG, GERMANY. 



the food, both of which are carried over- 
ground. 

The new Barmbeck III, City Hospital 
at Hamburg (Fig. 6), built by Baurat 
F. Ruppel, consists of forty-four build- 
ings, and will house fifteen hundred 
patients. In this plan Ruppel has varied 
somewhat from his usual method, in plac- 
ing the center of the medical unit — the 
bath-house — on the axis of his plan. In 
the St. Georg, the Eppendorf, the Vir- 
chow, and other large German hospitals 
the bath-house is placed on the medical 
side, balancing the operating building as 
the center of the surgical side. 

In the Barmbeck, coupled with the 
medical center, is the patients' entertain- 
ment hall, which is used also for a 



and between these there are underground 
passageways. 

The administration is in the center, 
flanked by the chapel and the nurses' resi- 
dence on one side and by the office and 
the home for the staff on the other. The 
surgical group has for its center the op- 
erating building; and the medical unit, a 
splendid bath-house. This bath-house is 
considered the finest in Europe connected 
with a general hospital, and will be de- 
scribed in another chapter. 

American Hospitals. The Peter Bent 
Brigham Hospital (Fig. 8), created by 
the bequest of six million dollars from 
the man for whom it is named, was 
opened in 1913. In the year 1907 a com- 
petition was held by the Trustees, seven 



8 



THE AMERICAN HOSPITAL 




1. Main building. 

2. Chapel. 

3. Sisters' building. 

4. Administration building and 

apothecary. 

5. Benzine building. 

6. Operation building. 

7. Main bath. 

8. Kitchen. 

9. Male out-patients' building. 
10. Female out-patients' building 



FIG. 7. 



11, 13. Male patients' buildings. 

12, 14. Female patients' build- 
ings. 

15. Disinfecting building and 
laundry. 

16. Garden and workshop. 

17. Machinery building. 

18. Animal experiment building. 

19. Pathological building. 

20. Segregation building. 

21. Contagion building. 

22. Skin and venereal building. 

PLOT PLAN, MUNICH-SCHWABING HOSPITAL 



V 1 



23. Mental disease building. 

24. Children's building. 

25. Gynecological building 

26. Janitors' quarters. 

27. Director's residence. 

28. Public lavatory. 

29. Main administration build- 

ing and residence. 

30. Coal house. 

31. Building for help of electric 

plant. 



MUNICH, GERMANY. 



architects being invited to submit plans, 
which resulted in the selection of Cod- 
man & Despradelle. Perhaps no hospital 
in America has had more study and 
thought put into it than has this institu- 
tion, and the plan is worthy of much 
study. Under the guidance of the super- 
intendent. Dr. H. B. Howard, the archi- 
tects and engineers have developed a 
comprehensive plan which gives the 
patient every advantage of open air, sun- 
light, and quick and quiet service. 

In planning for the Cincinnati General 



Hospital (Fig. 10), the City was wise in 
the selection of a site which would give 
sufficient room for growth. It was also 
wise in its appointment of the late Dr. 
Christian R. Holmes as medical adviser, 
since the time and thought he gave to this 
institution, after studying foreign and 
American hospitals, has made it one of 
the leading hospitals of the world. Dr. 
Holmes was ably assisted by the archi- 
tects, Samuel Hannaford & Son. 

The grouping of the buildings of the 
Royal Victoria Hospital, Montreal, Can- 



OF THE TWENTIETH CENTURY 



9 




10 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



11 




B U H /I E T AVENUE 



FIG. 10. PLOT PLAN, CINCINNATI GENERAL HOSPITAL, CINCINNATI, OHIO. 



ada (Fig. 11), is interesting because of its 
situation on a hillside overlooking the 
city. The new private pavilion is the 
highest building of the group, one hun- 
dred feet above the rest of the hospital. 
Back of it is the patients' park. 

In the Notre Dame Hospital, Montreal 
(Fig. 88), the problem was somewhat 
unique. The site is a restricted one, and 



on the south side of the lot an existing 
building had to be recognized and used 
to the best advantage. Another element 
in the problem was the steep grade. An 
H-shaped building was adopted as giving 
the maximum amount of service for the 
available land. Its left wing will not be 
built at first. Provision is made when it 
is completed for 500 patients, ward and 




FIG. 12. BLOCK PLAN, OTTAWA CIVIC HOSPITAL, OTTAWA, ONTARIO 
Stevens & Lee, Architects. 



OF THE TWENTIETH CENTURY 



13 



POWER, 
HOUSE 



PPJVATE 
PATIENT^ 
PAVIUON 



JEHYICE BUILDING 



MAIN £> U 1 L D 1 W &. 



T TTTTTTTTT" 



NURJEJ 
HOME 



FIG. 13. PLOT PLAN, VICTORIA GENERAL HOSPITAL, HALIFAX, NOVA SCOTIA. 




FIG. 14. 



OF THE TWENTIETH CENTURY 



15 



- ' A 
V 



X 




a. 



1 V ^v V 



• ' a — £ .... i . yv 

A\> fflA m * * r /vX s > vVA 



A 



V,' 



FIG. 16. TYPICAL FLOOR PLAN, GOOD SAMARITAN HOSPITAL, CINCINNATI, OHIO 
Gustave W. Drach, Architect. 



private. A residence for the Sisters and 
one for the nurses will be added later. 

Jn locating the Ottawa Civic Hospital, 
Ottawa, Canada (Fig. 12), careful study 
was made to secure a high, well-drained 
site, near the city, of sufficient area to 
provide for future extensions, and for 
recreation grounds for patients and staff. 
Though set in a plot of twenty-three 
acres, it is a block, or self-contained, 
building. Under ordinary conditions, a 
hospital of two-story, separate pavilions 
would have been built ; but with the pres- 
ent enormously increased cost of build- 
ing, high wages for the help to care for 
it, difficulties in getting nurses, etc., a 
concentrated service is more economical 
and more manageable. 



The H-shaped building, practically two 
T-shaped buildings, far enough apart for 
air and sun, is planned as two services, 
there being no necessity for crossing be- 
tween the two. Elevators take the place 
of wagons or carriers overground, thus 
doing mechanically what would otherwise 
be done manually. The section of the 
building (Fig. 85) shows the relation of 
the various departments. It is as good 
practice to divide the hospital horizontally 
as vertically. Separate floors are as dis- 
connected as separate buildings. 

The Victoria General Hospital, Hali- 
fax, Nova Scotia (Fig. 13), and the 
Bridgeport Hospital, Bridgeport, Conn. 
(Fig. 14), show how additions may be 
successfully made to existing buildings. 




B O UIwCVAP-D 

FIG. 1?. PLOT PLAN— ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. 



OF THE TWENTIETH CENTURY 



17 



The Good Samaritan Hospital, Cincin- 
nati, Ohio (Figs. 16, 17), is an interesting 
example of an orientation planned with a 
view to securing the greatest amount of 
light and sunshine. The main building, 
five, and in parts seven stories high, is in 
the form of an irregular St. Andrew's 
cross, the center being a huge rotunda. 
A feature of the plan is the locating of 
the serving kitchens at the juncture of the 
wings, each supplying two sections of the 
building. 

The detached buildings of many of the 
European hospitals seem ideal for the 
climate for which they are built ; but in 
America, especially in the rugged climate 
of the northern part, protection must be 
given the patient in going from building 
to building, and connecting corridors, at 
least, are generally provided. In the mild 
climate of Florida, however, at St. Luke's 
Hospital (Fig. 18), Jacksonville, it has 
been possible to build detached pavilions 
with open corridor connection. 

The group will consist of fourteen 
buildings, eight of which are finished and 
occupied. The administration building 
is in the center, with the ward and treat- 
ment buildings to the south. There are 
six or eight of these ward and treatment 
buildings, only two being now built. The 
domestic building, containing kitchen and 
dining-rooms, is directly behind the ad- 



ministration, while the power house and 
laundry are still farther back. The 
nurses' residence occupies a position cor- 
responding to that of the private ward. 
Two buildings for the care of com- 
municable diseases are also provided. 

The administration building contains 
not only the offices of the institution, but 
also the accident department, the admit- 
ting department, and, in the second story, 
a thoroughly equipped operating depart- 
ment and medical treatment rooms. 

The ward unit is planned to eliminate, 
as much as possible, the general noise of 
the hospital, and to give an abundance of 
open-air balconies. The private ward 
unit has a large open-air ward on the 
second floor. 

The isolation building is so planned that 
patients can be treated individually, after 
the manner of the Pasteur Hospital at 
Paris. (See description in Chapter 
VIII.) 

Memorial Buildings. A hospital build- 
ing or ward is certainly a most satisfac- 
tory memorial to anyone, since it is one 
which functions twenty-four hours in a 
day, every day in the year. As a memo- 
rial to the men who died in the world war 
there would seem to be no more fitting 
monument. In it should be placed the 
tablets or other records of the names of 
those in whose memory it was built. 



18 



THE AMERICAN HOSPITAL 



CHAPTER II. 



GH)e &bmtmgtratton department 




FIG. 19. MASSACHUSETTS GENERAL HOSPITAL, 
BOSTON, MASS. 
(From an old wood cut.) 



Whether it is a large institution or a 
hospital of twenty beds there must be 
headquarters for the administrator or di- 
rector. This department may vary from 
a single room to a vast building with ad- 
mitting rooms, waiting rooms and staff 
rooms. 

From careful observation, it would 
seem desirable to have the administrative 
unit the center through which all patients 
(except stretcher cases) and all their 
friends shall pass, and where the general 
business of the institution shall be con- 
ducted. 

Waiting space should be provided for 
visitors who may come in numbers be- 
fore the visiting hour. There should be 
offices of the superintendent, admitting 
officer, bookkeeper, and superintendent 
of nurses ; the staff and board room, and 
the medical library. The sleeping and 
sitting rooms of the house staff and in- 
ternes can be located in this department 
building. 

In the smaller hospital, the laboratories 
and Roentgen-ray, the autopsy and lecture 
rooms, and at times the kitchen depart- 
ment work out most satisfactorily in this 
unit. 

The entrance to this department should 
be carefully studied from the psychologi- 
cal standpoint, with reference to the ef- 
fect on the would-be patient. Decoration 
should play an important part in it. The 
architect should be allowed to depart from 



the severe design which char- 
acterizes other portions of the 
building, though over-elabora- 
tion should be avoided on ac- 
count of its obvious expense. 

In the entrance hall or 
rotunda should be located any 
memorial or other tablets 
which are desired. Soldiers' 
and sailors' memorials are just 
now in demand. These tablets 
should be so designed as to be 
a part of the wall panelling, 
not merely hung in a vacant 
space (Fig. 23). A good design is a 
grate fireplace, with the tablets forming 
a part of the frieze of the mantel. 

The walls and ceiling of the entrance 
hall may be decorated with bas reliefs or 
paintings. The furniture should be of a 
type at once dignified and decorative. The 
floors may be of tile or marble, with cork 
tile in the working space for the comfort 
of the attendants' feet. Exposed radia- 
tors should be avoided ; they may be 
concealed behind removable grille work, 
as in Fig. 24. 

The information desk should be in 




FIG. 21. HOSPITAL ENTRANCE. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



19 





evidence, and should be either labelled or 
so plainly indicative of its purpose that 
there shall be no hesitation on the part 
of the person who enters as to where to 
go for direction. At this desk there 
should be every facility for answering 
questions in regard to the condition of 
patients, the location of wards or rooms, 
hospital rules, payments, hotels, restau- 
rants, car lines, trains, etc. 

To show that a hospital can be success- 
fully run without a so-called administra- 
tion building, it may be noted that the 
Massachusetts General Hospital, Boston, 
one of the oldest in the country, built by 
Architect Bulfinch in 1821 (Fig. 19), did 
not have an administration building until 
1916; so that, with the hundred years in 
which to study the needs, it is not surpris- 
ing that the plan is well-nigh perfect 
(Figs. 26, 27). 

To the entering visitor, the broad mar- 
ble information counter at once invites 
confidence; and with the ample waiting- 
room in the center and the various offices 



FIG. 22. AMBULANCE ENTRANCE, BROCK- 
TON (MASS.) HOSPITAL. 
Kendall, Taylor & Stevens, Architects. 



THE AMERICAN HOSPITAL 




FIG. 23. ENTRANCE HALL, BENJAMIN STICKNEY CABLE MEMORIAL HOSPITAL, 

IPSWICH, MASS. 
Edward F. Stevens, Architect. 



of the institution around the perimeter, 
one is not apt to lose his way. 

The plan is self-evident. The casualty 
entrance from the same court comes into 
the basement (Fig. 27), where there are 
minor operating and treatment rooms. In 
the upper stories are the rooms of the 
staff. 

At the Peter Bent Brigliam Hospital 
(Fig. 9), the design is more imposing. 
In the large rotunda (Fig. 28) the circu- 
lar desk is obviously the source of in- 
formation. The offices of the superin- 
tendent and his assistants, and that of the 
superintendent of nurses, as well as the 
admitting and examining rooms, are 
grouped around the rotunda. In the base- 
ment are located the Roentgen-ray depart- 
ment and the pharmacy. The central lo- 
cation of this building, connecting as it 
does the approach to all departments of 



the institution, simplifies the problem of 
surveillance. 

In the Ottawa Civic Hospital, Ottawa, 
Canada (Fig. 80), a large lobby is pro- 
vided. The information desk is plainly 
in view at the right of the entrance, the 
cashier's desk just around the corner for 
privacy's sake. The offices of the super- 
intendent, assistant superintendent, and 
superintendent of nurses are at the rear, 
somewhat secluded. The record rooms 
are easily accessible, and there are ample 
rooms for the clerical force. A doctors' 
coat room, library, consultation room, etc., 
are provided. 

In the Notre Dame Hospital, Montreal 
(Fig. 88), the main entrance is formal 
and dignified. The rather simple admin- 
istration portion is concentrated near the 
entrance. The wards for patients begin 



OF THE TWENTIETH CENTURY 



21 



very near to the administration, but are 
shut off from it. 

At St. Luke's Hospital, Jacksonville, 
Fla. (Figs. 29, 30), the administration 
building houses the operating and acci- 
dent rooms, the medical treatment, X-ray, 
laboratory, and the superintendent's and 
internes' quarters. 

At the Ohio Valley General Hospital 
which is a block-type, self-contained 
building, the ground and first stories are 
set aside for administration and domestic 
purposes. The main and ambulance en- 
trances, the laboratories and treatment 
room, the out-patients' and the isolation 
rooms are on the ground floor ( Fig. 99), 
while the main administrative offices, the 
internes' quarters, the kitchen and dining 
rooms are on the first floor (Fig. 100). 
This concentrates all of the non-profit- 
bearing portion of the building near the 
ground and the less interesting outlook. 




FIG. 28. VIEW IN ROTUNDA, PETER BENT 
BRIGHAM HOSPITAL, BOSTON, MASS. 
Codman & Despradelle, Architects. 

Fig. 31 shows a simple, homelike 
entrance to a small hospital. 

In large hospitals, it may be found de- 
sirable to have a receiving department,. 




FIG. 24. 



ENTRANCE HALL, ROSS PAVILION, ROYAL VICTORIA HOSPITAL, MONTREAL. 
Stevens & Lee, Architects. 



11 



THE AMERICAN HOSPITAL 




FIG. 25. ADMINISTRATION BUILDING, MASSACHUSETTS GENERAL HOSPITAL, 

BOSTON, MASS. 
Coolidge & Shattuck, Architects. 




PLAN OF FIRST FLOOR 

1 Main entrance to Hospital 

2 Information office 

3 Stairs to public toilet for men 

4 ' Waiting room for patients to be ad- 
mitted 

6, 6, 7, 8, 9, 10 Telephone booths 

11 Admitting Physician's office 

12 Outside corridor to yard 

13 Record Clerks' office 

14 Corridor to Main Hospital 

15 Cashier's office 

16 Elevator 

17 Bookkeeper's vault 

18 Bookkeeper's office 

19 Office of First Assistant Resident 

Physician 

20 Office of Resident Physician 
21- Trustees' room 

22 Private toilet 

23 Cleaners' closet 

24 Clerks' office 

26 Office of Superintendent Of Nurses 

26 Office of Assistant Superintendents of 

Nurses 

27 Office of Assistant Resident Physicians 

28 Telephone switchboard room 
29, 30 Reception rooms 

31 Office of Assistant Resident Physician 

32 Parcel room 

33 Main waiting room for visitors 

34 Stairs to public toilet for women 



FIG. 26. FIRST FLOOR, ADMINISTRATION BUILDING, MASSACHUSETTS GENERAL HOSPITAL. 

BOSTON, MASS. 
Coolidge & Shattuck, Architects. 



OF THE TWENTIETH CENTURY 



23 



PLAN OF BASEMENT FLOOR 

1 Corridor to ambulance entrance 

.2 Isolation room 

3 Dark room 

4, 5, 6, 7, 11, 12 Operating and examining 

rooms 

8 Air chamber 

- 9 Splint room 

10 Covered incline to possible future 

buildings 

13 Ward service room 

14, 15 Male and female emergency wards 

16 Ward kitchen 

17 Linen room 

18 Blanket-warming room 

19 Sterilizing room 

20 Instrument room and medicine closet 

21 Storage .vault 

22 Disinfecting room 

23 Staff dressing room 

24 Tunnel under Fruit St., to Nurses' 

Home 

25 Women employees' rest room 

26 Women employees' dressing room 

27 Patients' toilet (women) 

28 Apparatus room 

29 Public toilet for women 

30 Storage 

31 Public toilet for men 

32 Cleaners' closet 

33 Patients' toilet (men) 

34 Emergency-ward bathroom 

35 Dressing room for men employees 

36 Emergency-ward office 

87 Entrance for ambulatory patients 

38 Central clothing room 

39 Elevator 




FIG. 27. BASEMENT FLOOR, ADMINISTRATION BUILDING, MASSACHUSETTS GENERAL 

HOSPITAL, BOSTON, MASS. 
Coolidge & Shattuck, Architects. 



located near the administration portion of 
the building. The Cincinnati General 
Hospital, Cincinnati, O., has an entire 
building used for this purpose (Fig. 32), 
and for ward clinics, an interesting and 
economical combination. 

In the Ottawa Civic Hospital, Ottawa, 
Canada, the admitting department for all 
patients is on the ground floor (Fig. 79). 
The ambulance entrance is ample in size 
and entirely protected from the weather. 
The admitting rooms are near this en- 
trance. There is a separate admitting 



department for maternity cases. There 
are two small detention wards for cases 
coming in at night or those suspected of 
being contagious. 

It may be found of advantage to use 
the same admitting room for both in and 
out patients, since the out-patient depart- 
ment is sometimes the sifting ground for 
in-patient material. The ground floor of 
the Notre Dame Hospital of Montreal 
(Fig. 87) shows an example of this 
arrangement. 



24 



THE AMERICAN HOSPITAL 




FIG. 29. ADMINISTRATION AND OPERATING BUILDING, ST. LUKE'S HOSPITAL, 

JACKSONVILLE, FLA. 




FIG. 30. FLOOR PLANS, ADMINISTRATION BUILDING, ST. LUKE'S HOSPITAL, 

JACKSONVILLE, FLA. 
Edward F. Stevens, Architect; Mellen C. Greeley, Associate Architect. 




FIG. 31. ENTRANCE TO SMALL HOSPITAL. 
Kendall, Taylor & Stevens, Architects. 




FIG. 32. 



OF THE TWENTIETH CENTURY 



27 



CHAPTER III. 



The subject of the ward unit has been 
discussed by so many able writers on hos- 
pital planning that one hesitates to say 
more on the topic; still, the ward unit is 
really the keynote of the hospital, since 
it is here that the patient for whom the in- 
stitution is built, lives, eats, sleeps, and 
spends his weary hours of convalescence. 
We should, therefore, never cease to study 
the best methods of filling those hours 
with as much comfort as possible ; how to 
serve him with palatable food ; how to 
provide him with fresh air and sunshine; 
and how to guard him from undue noise 
and from the excitement caused by the 
workings of the hospital. 

The planning of the ward unit, whether 
in a hospital of one hundred or one thou- 
sand beds, presents the same problem — 
how best to care for the patient. After 
more or less careful study of hospital 
buildings in Europe and America, after 
consultation with many of the leading 
hospital authorities, and after living in 
the hospital and seeing the operation and 
treatment, it appears to the writer that 
there are certain fundamentals which 
every ward unit should possess — i.e., 
every ward unit of a general hospital 
where the surgical, the usual medical, and 
special cases are treated, or where the 
general run of cases are cared for. These 
essentials of planning can be classed 
under two heads : 

(a) Comfort of Patients. The com- 
fort and care of the patients are inva- 
riably the first things to be considered. 
Around this center — the patient — we 
build our institution. If the supply- 
ing of more light, better air, and free- 
dom from disturbing noises will add 
to the comfort and hasten the conval- 
escence of the patient, then these things 
must be provided. 

(b) Accessibility of Service. The 
utility rooms should be so near and so 
well equipped that the patient need not 
be called upon to wait for service. At 
the same time, these service rooms 



should be so planned that the necessary 
noises therefrom will not be a menace 
to speedy convalescence. 

Proportions. — From a careful investi- 
gation of modern ward units for the care 
of general cases — of eighteen to twenty- 
four beds per floor — it has been found 
that an average of twenty-five per cent 
of the area of a floor is needed for stair- 
cases, elevators, and utilities, and twenty- 
five per cent for corridors, leaving fifty 
per cent for patients. Circumstances 
will, of course, change this proportion. In 
contagious wards the proportion for utili- 
ties will be greater, while in those for in- 
cipient tuberculosis it will be less. 

The ward unit should be planned for 
the particular class of disease which is to 
be treated in it. The conditions which 
govern the treatment of acute surgical 
patients are different from those govern- 
ing chronic medical cases. The ambu- 
latory tuberculosis patient needs different 
accommodations from the patient suffer- 
ing with the same disease in an advanced 
form; the child from the adult; the con- 
tagious from the psychopathic case. 

There are a few essentials applicable 
to all classes of cases. Whatever the case 
(with a possible exception of eye cases), 
the ward or bed of the patient should be 
so placed that it is possible to have sun- 
shine in the room and near the bed some 
part of the day. All necessary inside 
doors and all doors or windows giving 
access to porches should be designed wide 
enough for the patient to be moved in his 
bed without any change and without any 
discomfort or inconvenience, to any part 
of the building, porches, or roof. 

As to the number of beds to be placed 
in a ward, authorities differ very much 
and local demands vary widely. The 
best authorities abroad believe that not 
more than sixteen, or, at the most, eigh- 
teen patients should be in one room, and 
some think that these should be subdi- 
vided for a better segregation. The ten- 
dency is to reduce the size of wards. In 



28 



THE AMERICAN HOSPITAL 




FIG. 32A. DAY ROOM — BENJAMIN STICKNEV CABLE MEMORIAL HOSPITAL, IPSWICH, MASS. 

Edward F. Stevens, Architect. 



this country there is an increasing demand 
for small wards, containing only a few 
beds. In the west and middle west, pay- 
ing patients usually prefer private rooms, 
no matter how cramped in size. 

In wards, every patient should have, 
when all windows and doors are closed, 
at least one thousand cubic feet of air. 
If we consider the height of the ceiling 
twelve feet, each patient should have not 
less than eighty-three square feet of floor 
space — one hundred is better. The height 
of the ceiling may depend upon the char- 
acter of the disease being treated, but 
any height above twelve feet is unneces- 
sary and is of little use in the purification 
of the air, since the breathing line is about 
three feet from the floor. On the other 
hand, for appearance's sake, a ward of 
more than ten beds should not be less 
than ten feet in height. The windows 
should be placed low enough so that a 



patient either in bed or in a chair can com- 
fortably see the street or grounds. 

Where wards are of any considerable 
size, there should be provided nearby one 
or more "quiet" rooms for delirious or 
dying patients. Delirious patients may be 
protected by furnishing simple iron grilles 
which can be shifted from one window to 
another. 

Every patient should have at least semi- 
privacy and some place in which to hide 
the "household gods" which he mav have 
brought with him. 

Many of our modern hospitals, for 
economy's sake, have a flat roof; and 
some of them use this roof to a limited 
extent for the care and treatment of pa- 
tients. These flat roofs should be used 
not only for observation, but, if partly 
covered for protection from storms and 
intense heat and partly open to the direct 
rays of the sun. a patient may be given 



OF THE TWENTIETH CENTURY 



29 




FIG. 33. WARD UNIT, RIGS HOSPITAL, COPENHAGEN, DENMARK 



open-air treatment. The regular ward 
service of toilet, sink room, serving 
kitchen, and linen and supply room should 
be provided here. 

In Europe the day room or conval- 
escent room is considered by the Govern- 
ment so important that every hospital is 
compelled to provide one for each ward 
or group of private rooms, allowing a 
little over nine square feet for each 
patient, thus making the area of the day 
room about one-tenth that of the ward or 
group of private rooms. In some institu- 
tions this room is used for a dining-room. 
The day room for wards allows a separa- 
tion of the convalescing patient and the 
really sick patient, to the advantage of 
each. The day room for private rooms 
affords a sitting room where the patients 
can receive their friends, gossip one with 
another, and get away from the monotony 
of their own rooms. 

Every ward unit, or section of private 



rooms, should have a serving kitchen of 
sufficient size, so placed as to allow 
quick serice of palatable food. The com- 
mon faults of serving kitchens are that 
they are too small, and that the arrange- 
ment of the equipment is inconvenient. 
Such rooms should be carefully planned 
around the equipment, instead of the 
equipment being adapted to the room af- 
ter the building is done. The things 
most used should be located so as to be 
most accessible; and the things which 
are needed together should be adjacent, 
in order to save time and confusion. 
There should be facilities for keeping 
food either hot or cold ; for cooking small 
diets ; for laying trays for patients, and 
for washing the china. (See Chapter 
XVIII, on "Equipment.") 

It is always necessary to have a sepa- 
rate utility room for the emptying, ster- 
ilizing, and storage of bed pans and urin- 
als, and such service. The soiled clothes' 




FIG. 34 



WARD UNIT, BISPEBJERG HOSPITAL, COPENHAGEN, DENMARK. 
M. Nyrop, Architect. 




FIG. 36. INTERIOR OF WARD, BISPEBJERG HOSPITAL, COPENHAGEN, DENMARK. 

M. Nyrop, Architect. 



OF THE TWENTIETH CENTURY 



31 




FIG. 37. OPERATING ROOM, BISPEBJERG HOSPITAL, COPENHAGEN, DENMARK. 

M. Nyrop, Architect. 



container may be placed here, unless a 
clothes' chute is used. Here, also, should 
be the gas stove for the making of poul- 
tices, the sterilizer for boiling instruments 
(unless special surgical dressing rooms 
are provided), the ice-crusher, the small 
ice storage box, the blanket warmer, etc. 
A local incinerator is sometimes found 
valuable for destroying ward waste, and 
can be placed in this room. 

The utility room and the serving 
kitchen, on account of their constant use, 
should have the walls tiled to at least four 
feet in height, and should be located so 
as to minimize annoyance from noises. 

Baths. With acute cases little use is 
made of the bath tub, so that in a general 
surgical or medical ward only a limited 
number is needed, one to fifteen or twenty 
patients. 

In tubercular wards, simple bathing fa- 
cilities should be provided, both tub and 
shower, since bathing usually forms a part 
of the treatment. 



For departments where patients need 
assistance in taking their baths, the tub 
should be set high above the floor. It 
should be placed so as to be accessible 
from both sides. There should be room 
for a wheel chair. 

In children's wards where the bath is 
always given by a nurse, the high, shal- 
low slab or tub, with spray, should be 
used. For the ward entrance bath, a sim- 
ilar tub has been found satisfactory. (See 
Fig. 392 in Chapter XVI.) 

Small medicine closets should be pro- 
vided in each service. These should have 
a small sink, and shelves sufficient for the 
ordinary supply of medicines. (See Fig. 
414.) 

The linen closet should be well venti- 
lated and lighted. Slat shelves insure bet- 
ter aired linen. (See Fig. 415.) 

Where there are large wards, the pa- 
tients' clothing can be better cared for in 
a general clothing room. For small wards 
or private rooms built-in cabinets or cup- 



OF THE TWENTIETH CENTURY 



33 



boards are desirable. The room vents can 
be carried through this closet. (See Fig. 
387.) V 8 

In buildings or sections for private pa- 
tients there should be a dressing and 
locker room for special nurses. 

The necessary toilets must be provided. 
A small laboratory is a great convenience. 
For surgical wards, a properly equipped 
surgical dressing room is almost a neces- 
sity; it saves much dirt and many odors 
in the ward, and adds to the comfort of 
other patients. In the Geisinger Memo- 
rial Hospital, Danville, Pa. (Fig. 57), 
there is a room for preparation and stor- 
age of dressings, instruments and sup- 
plies, and for surgeons' scrub-up, etc., 
though the actual dressings are done in 
the patients' rooms. 

Where there are many private patients, 
there should be a small room with sink 
where cut flowers can be taken at night 
and rearranged in the morning; this pre- 
vents the clutter which one finds in the 
bath or sink room on morning rounds. 

For the convenience of doctors and at- 
tendants, lavatories should be placed in 
every room or in the corridors adjoining. 
Drinking fountains, preferably of the 
"bubbling" type, add to the comfort of 
both patient and nurse. 

Noises. — There is nothing more dis- 
turbing to a sick patient than street noises, 
the ringing of electric bells, the clatter of 
dishes, clicking of doors, hum of conver- 
sation, the flushing of plumbing, etc. He 
wants quiet and grumbles if it is denied. 
The minimizing of hospital noises is one 
of the architect's problems. It cannot be 
accomplished by putting legends on the 
wall, warning the visitor, doctor, or nurse 
to "keep silence." It must be done by 
planning. With modern fireproof con- 
struction, hard-plaster finish, lack of 
draperies, and necessary elimination of 
architectural detail the very walls become 
sounding boards, which transmit and 
magnify noises throughout the building. 

Hospitals should be so planned that 
noises are confined, as far as possible, to 
the localities in which they originate. 

Much elevator and staircase noise can 
be avoided if these are enclosed in one 
shaft, away from wards or private rooms, 




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34 



THE AMERICAN HOSPITAL 




FIG. 40. WARD UNIT, PETER BENT BRIGHAM HOSPITAL, BOSTON, MASS. 
Codman & Despradelle, Architects. 



OF THE TWENTIETH CENTURY 



35 




FIG. 41. INTERIOR OF WARD 1, PETER BENT BRIGHAM HOSPITAL, BOSTON, MASS. 
Codman & Despradelle, Architects. 




FIG. 42. INTERIOR OF WARD 2, PETER BENT BRIGHAM HOSPITAL, BOSTON, MASS. 



36 



THE AMERICAN HOSPITAL 




FIG. 43. AIRING BALCONY, PETER BENT BRIGHAM HOSPITAL, BOSTON, MASS. 
Codman & Despradelle, Architects. 



with a wide landing in front, shut off 
from the main corridor by a door. 

In a well-planned private house, the 
kitchen is never connected with the liv- 
ing rooms nor directly even with the din- 
ing-room ; yet in modern hospitals we 
sometimes find the serving kitchen next to 
or directly opposite a patient's room or 
ward, with the clatter of dishes disturbing 
him many times a day. This is also quite 



true with other utility rooms such as sink 
room or public toilets. If these utilities 
can be segregated, placed at the end, the 
center, or even around the corner of the 
ward building, there will be much greater 
freedom from these disturbing noises. 

In maternity departments, the nursery, 
the delivery room, and the labor room 
should be as far as possible from patients' 
rooms, and should be isolated by at least 




FIG. 44. WARD UNIT PLAN, CINCINNATI GENERAL HOSPITAL, CINCINNATI, OHIO. 
Samuel Hannaford & Sons, Architects. 



OF THE TWENTIETH CENTURY 



37 




FIG. 45. INTERIOR OF WARD, CINCINNAT 
Samuel Hannaford 

two intermediate doors. (See Chapter 
VI, on "Maternity Department.") It 
should be remembered that open windows 
in warm weather readily transmit noises ; 
hence the importance of location. 

The operating department should be 
well removed from all others, preferably 
on a separate floor or in a separate 
pavilion. 

Floors which minimize the noise, either 
of cork or linoleum, should be used in 
the sick rooms ; noiseless hardware and 
door checks to prevent slamming, etc., 
should be considered in the construction 
of the building. 

Outside noises, such as street cars, rail- 
roads, traffic on the pavement, manufac- 
turing plants in the vicinity, etc., can be 
avoided only by proper location. This 
should receive serious consideration. 

A few examples of both the European 
and the American ward units will serve 
to illustrate some of the important points. 

EUROPEAN WARD UNITS. 

In the Barmbeck Hospital, Hamburg, 
Germany (Fig. 6), the largest ward is 



: GENERAL HOSPITAL, CINCINNATI, OHIO. 
& Sons, Architects. 

sixteen beds ; from each ward is a liege- 
halle or airing balcony ; each ward has its 
tageraum or day room ; the serving kit- 
chen, sink rooms, and toilets are removed 
from the vicinity of the patients' rooms; 
and each ward unit has a laboratory and 
a surgical dressing room. This ward 
building proper is two stories in height, 
with room on the third floor for a few 
nurses for quick call. 

The operating building of this hospital 
of fifteen hundred beds has but two op- 
erating rooms, so that many of the minor 
surgical procedures are done in the sur- 
gical dressing rooms which are in each 
unit. The Barmbeck unit is an unusually 
good and complete one. 

The Rigs Hospital, Copenhagen, Den- 
mark, Ward Unit* (Fig. 33), has much 
to commend it worthy of study, for it is 
in many ways unique. The staircase, 
elevator, and other noisy equipment are 
kept at the extreme ends, away from the 
portion of the building occupied by 

*When the scale is not placed on a plan, the size of 
the rooms can be estimated by noting the size of the 
beds, which are usually 3 ft. by 6 ft. 6 in. 



38 



THE AMERICAN HOSPITAL 




FIG. 46. FRONT, WARD BUILDINGS, CINCINNATI GENERAL HOSPITAL, CINCINNATI, OHIO. 
Samuel Hannaford & Sons, Architects. 





FIG. 47. REAR, WARD BUILDINGS, CINCINNATI GENERAL HOSPITAL, CINCINNATI, OHIO. 
Samuel Hannaford & Sons, Architects. 



OF THE TWENTIETH CENTURY 



39 




P1E.ST TLGOE. PLAN 



- PBIVATE' PATI ENT - blMLDI NO ■ 
■ HENRY- rOED-H05PlTAL-PETE01P MICH." 



FIG. 48. 



1 Operating Room. 2. Sterilizing Room. 3. Operating Amphitheater. 4. Nurses' Work Room. 
5* Emergency Operating Room. 6. Passage. 7. Doctors' Wash Room. 8. Anesthetizing Room. 9. Dark 
Operating Room 10. Utility Room. 11. Emergency Receiving Room. 12. Laboratory. 13. Doctors' Phone. 
14 Doctors' Offices. 15. Rear Entrance. 16. Doctors' Locker Room. 17. Toilet Room. 18. Waiting 
Room 19 Accounting Room. 20. Phone Exchange. 21. Office. 22. Private Room. 23. Bath. 24. Alcove. 
25 Linen 26 Utility 27. Diet Kitchen. 28. Dressing Room. 29. Head Nurse. 30. Doctors' Phone. 



40 



THE AMERICAN HOSPITAL 



















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Second Floojl Plan 



FIG. 49. PRIVATE PAVILION, HAMOT HOSPITAL, ERIE, PENN. 
Edward F. Stevens, Architect. C. Paxton Cady, Associate. 



patients. The serving kitchen, bath and 
sink rooms are on a cross corridor; the 
surgical dressing rooms and toilets are at 
the opposite end of the building. An 
isolation room and nurses' room are 
placed in the center. 

The ward itself, containing twenty-six 
beds, is divided into eight sections, each 
section containing three or four beds. A 
dividing screen affords privacy to the 
patients and still allows free access to 
all parts of the room for the attendants. 
The screens, only six feet high and raised 
one foot from the floor, afford the same 
ventilation as an open ward. Bowls for 
surgeons' use and medicine closets are 
placed in each ward. 

This is doubtless one of the best de- 
veloped ward units in Europe. 



In the Bispebjerg Hospital, Copen- 
hagen, Denmark (Fig. 34), the war unit 
is interesting, sixteen beds being the 
largest ward. The details of the various 
equipment was very carefully devised. 

In the Munich-Schwabing (Fig. 38) 
unit the largest ward is twelve beds. All 
wards face the south and have oppor- 
tunities for wheeling patients into the bal- 
conies and into the gardens. The bal- 
conies are spacious and comfortable with 
attractive boxes of flowers decorating 
them in summer. The service rooms are 
to the north, also the laboratory and dress- 
ing rooms. The day room is to the south, 
central with the unit. 

The admitting department for each 
ward unit is very complete. The patient 
comes into room No. 1 1 ; his clothes are 



Coof Garden 




FIG. 50. PRIVATE PAVILION, HAMOT HOSPITAL, ERIE, PENN. OPERATING DEPARTMENT. 
Edward F. Stevens, Architect. C. Paxton Cady, Associate. 



OF THE TWENTIETH CENTURY 



41 




FIG. 51. HAMOT HOSPITAL, ERIE, PENN. 
Edward F. Stevens, Architect. C. Paxton Cady, Associate. 



removed and put into a container of linen 
which is hung on a truck ; he next goes to 
room No. 12, where he is bathed; to No. 
13, where he is given hospital clothes; 
passes to No. 8, where final examination 
is made and history completed, and thence 
to his bed. The elevator at this part of 
the building is for the convenience of the 
second-story patients. 

AMERICAN WARD UNITS 

The European hospitals are built and 
supported very largely by the govern- 
ments. In this country, we have a very 
different condition. Many of our hos- 
pitals are private corporations, and it is 
generally a question of accommodating 
the largest number of patients for the 
smallest amount of money. Our archi- 
tects, therefore, are often forced to econ- 
omize in every way, until the wards in 
many cases have become almost barracks 
for the mere housing of people, and the 



attendants are obliged to put up with the 
scantiest accommodations. 

Some of our newer hospitals are rising 
in scale. Instead of making a number 
of rooms and leaving it to the adminis- 
trator to find out later what he can put 
into these rooms, they are allowing their 
architects to provide some of the more 
essential rooms, such as the sink room, 
a serving kitchen of sufficient size, a surg- 
ical dressing room, laboratory, etc. ; and 
are letting him design and plan the equip- 
ment at the time he makes the drawings 
for the building. 

The care and thought put by Dr. H. B. 
Howard, upon the working out of the plan 
of the Peter Bent Brigham Hospital, Bos- 
ton (Figs. 40-42), make it worthy of 
attention. 

The first floor of the ward unit con- 
tains two large wards, one of eight and 
the other of fourteen beds. A cross cor- 
ridor separates the two wards. Two iso- 



42 



THE AMERICAN HOSPITAL 



roruet £htcnjion 




FIG. 52. PRIVATE PAVILION, BUFFALO GENERAL HOSPITAL, BUFFALO, NEW YORK. 

Edward F. Stevens, Architect. 




FIG. S3A. CONNECTING CORRIDOR AND AIRING BALCONY BETWEEN THE PRIVATE PATIENTS' 
BUILDING AND ADMINISTRATION BUILDING-BUFFALO GENERAL 
HOSPITAL, BUFFALO, N. Y. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



43 




FIG. 54. EXTERIOR PRIVATE PAVILION-BUFFALO GENERAL HOSPITAL, BUFFALO, N. Y. 

Edward F. Stevens, Architect. 



lation rooms, with diet kitchen, duty 
room, baths and toilets, are grouped to- 
gether on the side of the corridor op- 
posite the main ward. There are, also, 
a laboratory and a consultation room on 
this floor. 

The staircase and elevator lead directly 
from the main corridor at the extreme 
north end of the building. 

In the second story there is one large 
ward of twelve beds, two isolation rooms, 
duty and toilet rooms. Ample airing bal- 
conies or terraces on both floors provide 
outdoor space for all the patients of this 
unit. 

The portion of the building containing 
the octagonal ward (Fig. 41) is but one 
story in height, and has monitor windows. 
The main ward, second story (Fig. 42), 
is also top-lighted. 

On the third floor (Fig. 40), there is 
an open-air ward, with the necessary duty 



room, toilet, and isolation rooms. This 
can also be used for contagious cases 
which may develop in the hospital. 

The Cincinnati General Hospital shows 
the influence of European examples. The 
late Dr. Holmes gave much thought to the 
perfecting of this ward unit (Figs. 
44-47). 

In this ward unit the nurses' station, 
while not directly in the main ward, is in 
such a position that it commands a view 
of all the ward beds, as well as the doors 
of the private rooms. 

The patients' toilet is entered through 
a fresh-air cut-off, after the manner of 
the best-planned English hospitals. The 
sink room is entered either through the 
nurses' work room or directly from the 
corridor. There are additional toilet fa- 
cilities connected with the solarium, thus 
minimizing the work of nurses or attend- 
ants. 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



45 




OF THE TWENTIETH CENTURY 



47 




The utilities, baths, and toilets are 
grouped together. The entrance to the 
serving kitchen is near the main stair and 
elevator corridor. A commodious dining 
room is provided for those patients who 
are able to be about. 

In the Henry Ford Hospital, Detroit, 
Mich (Fig. 48), the ward unit provides 
for sixteen beds in the general ward, one 
two-bed ward and two single rooms. The 
patients' toilet is entered indirectly from 
the ward through a fresh air passage. 
There are also additional toilets, entered 
from the solarium or day room. The ar- 
rangement of the private ward unit and 
the operating building are shown in Fig. 
48. 

The recent addition to the Hamot Hos- 
pital, at Erie, Penn., consists of a seven- 
story fireproof building (Fig. 51) which 
is devoted largely to private rooms and 
surgical department of the hospital. This 
pavilion is designed as the first unit of an 
entirely new Hamot Hospital, but is com- 
plete in itself. In this ward unit, all the 
utilities are grouped at one end of the 
building; the stair hall and elevator are 
shut off from the main corridor; the sink 
room and serving kitchen are at the ex- 
treme end of the building. A large 
solarium and airing balcony are on the 
southwest end of the building on each 
floor. Fig. 49 shows a typical floor. 

The private ward unit of the Buffalo 
General Hospital, Buffalo, N. Y. (Figs. 
52, 53, 54), provides for suites with baths, 
and comfortable single rooms with a lava- 
tory in each. The sink room and the 
serving kitchen open from cross corridors 



to avoid noise. A special room, with 
sink, is provided for flowers. 

In the addition to the Victoria Gen- 
eral Hospital, Halifax, N. S. (Figs. 55- 
56), the problem was to connect the 
new ward building with the existing serv- 
ice building. It could not be done through 
basement nor wards, but was accom- 
plished by making a corridor through the 
attic of the old building and connecting 
it by a bridge to the third floor of the 
new. The lift takes food direct to the 
servery on each floor. 

The first floor has a small office, a wait- 
ing room for visitors, a doctors' room, an 
examining room, and an office for the 
supervisor. There are two three-bed 
wards and fourteen private rooms, each 
having its own lavatory. There are two 
sink rooms, a flower room, ample balco- 
nies and all needed utilities. The second 
floor has two rooms with connecting bath 
and private balcony. Special features are 
the projecting nurses' station which gives 
a view of the whole floor, and the placing 
of the utility rooms on side corridors to 
obviate noise. 

In the private patients' pavilion of the 
George F. Geisinger Memorial Hospital, 
Danville, Pa (Figs. 57, 58, 59) the first 
floor has ten double rooms or two-bed 
wards, each with two closets for clothing 
and its own lavatory. There is a large 
solarium, a large open balcony, a consul- 
tation room, a surgical dressing room, and 
two sink rooms, with other utilities cen- 
trally located. The second and third 
floors each have four sets of rooms with 
a communicating bath between, a surgi- 



THE AMERICAN HOSPITAL 



50 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



51 




FIG. 62. HUDSON MEMORIAL BUILDING, HARPER HOSPITAL, DETROIT, MICH. 
Malcomson & Higginbotham, Architects, Detroit, Mich. 
Edward F. Stevens, Consulting Architect, Boston, Mass. 



cal dressing room (used chiefly for prep- 
aration, storage, scrub-up, etc.), a flower 
room, an extra hopper room, with bal- 
conies and utilities as on the first floor. 

The hospital for the Tennessee Coal, 
Iron and Railroad Company at Birming- 
ham, Ala. (Figs. 60-61), is planned 
so as to secure the maximum amount of 
light and air. The small wings make it 
possible to easily isolate any special 
cases, such as venereal. There are both 
wards and private rooms with ample utili- 



ties. The operating rooms are in the cen- 
tral building on the third floor. 

In the six-story building recently 
erected for the Harper Hospital (Figs. 
62 and 63), Detroit, an innovation has 
been introduced into the construction by 
making eight-foot set-backs in the walls 
of the main pavilion at the fourth floor so 
that the first three stories provide for 
private rooms on either side of a wide 
corridor. The upper three stories provide 
for a ward on each of proper width for 




DDDDDD DDDDD 



□ DDDQ W DDDDD 




FIG. 63. HUDSON MEMORIAL BUILDING, HARPER HOSPITAL, DETROIT, MICH. 
Malcomson & Higginbotham, Architects, Detroit, Mich. 
Edward F. Stevens, Consulting Architect, Boston, Mass. 



OF THE TWENTIETH CENTURY 53 




FIG. 65. EXTERIOR OF PRIVATE PAVILION, ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. 
Edward F. Stevens, Architect. Mellen C. Greeley, Associate. 



administration. This allows for two 
large airing balconies on the fourth floor, 
over the roof of the third-story private 
rooms. 

In this plan, also, the utilities are 
grouped in the center, with a fresh air 
cut-off between them and the main 
twenty-two-bed ward. At the end of the 
large wards toilet rooms are provided, in 
addition to the general toilet rooms from 
the main corridor. 

For every story there are surgical dress- 
ing rooms, and on the private room floors 
a special room for cut flowers is intro- 
duced. The seventh story consists of a 
large roof ward, with diet kitchen and 
other utilities. 

In the St. Luke's Hospital, Jackson- 
ville, Fla., it was planned to have several 
public ward units (Fig. 66), accomo- 
dating thirty-six patients in each build- 
ing, the largest ward containing but six 
beds. The entrance is from the open-air 
corridor at the east, and the utility rooms 
are grouped around this entrance, with 
the doors to sink room, serving kitchen, 



nurses' toilet, and elevator opening from 
the cross corridor, minimizing the noises 
from these disturbing elements. Two 
large airing balconies are provided on each 
floor. 

In the private pavilion of the same hos- 
pital (Fig. 64) a similar arrangement is 
secured so far as the utilities are con- 
cerned. The units are smaller, a three-bed 
ward being the largest, most of the space 
being utilized for single rooms. In this 
plan, the open-air ward is introduced on 
the second floor, being connected with the 
main corridor and served from the main 
utility rooms. Both this building and 
the public ward unit are but two stories in 
height. 

In the Youngstown Hospital at 
Youngstown, Ohio, the ward unit (Fig. 
68) is not unlike some of the others de- 
scribed, providing for a central location 
of the utilities, with sufficient isolation 
for the rooms and wards to minimize the 
effect of noises upon the patients. 

The first ^oor of this pavilion is used 
only for ward patients; and the second, 



54 



THE AMERICAN HOSPITAL 




third, and fourth floors for private pa- 
tients. On the north there is a day room 
on each floor, and a large roof ward on 
the fifth floor. 

The ward unit used in the maternity 
and children's department of the Bridge- 
port Hospital at Bridgeport, Conn., is 
one which will apply to any general ward 
(Fig. 69), and is described under the 
chapters on maternity and children's hos- 



pitals. (See also Figs. 70-74.) This unit, 
designed on the Rigs Hospital ward plan, 
affords a better division of patients than 
almost any other plan of the same area. 
It is arranged in groups of four beds. 
The division between the groups is made 
by a permanent screen, upon which are 
placed the connections for the nurses' 
calls and the electric lights. 

The utilities and quiet room are plan- 
ned for the most efficient service. 

GENERAL HOSPITALS 

The Galloway Memorial Hospital at 
Nashville, Tenn. (Fig. 75), consists of a 
group of three buildings, the first one to 
be erected being in the center, and is com- 
posed of an operating pavilion, charity 
ward pavilion, and private ward pavilion. 

In the operating pavilion the basement 
floor is to be used for administrative pur- 
poses and to the rear an ambulance porch 
shelters patients being received. The sec- 
ond floor consists of the operating de- 
partment, together with dressing rooms, 
sterilizing, anaesthetic and recovery 
rooms, and all other modern arrangements 
necessary to a thoroughly equipped oper- 
ating department. The third floor is simi- 
larly fitted for a charity operating depart- 
ment, and is furnished in every particu- 
lar with the same conveniences and ad- 
vantages that the pay service will afford. 

The right wing is for charity patients 
only. The basement floors are used for 
consultation, emergency beds and a free 
dispensary. The second and third floors 
hold one hundred charity beds, conveni- 
ently arranged, with one to twelve beds 
per room. The roof garden, to which the 
patients have access for fresh air and sun- 
shine, is reached by an elevator. 

In the left wing, the basement floor for 
the present will furnish space for kitchen, 
dining-rooms and domestic service. The 
second and third stories contain thirty- 
two rooms for pay service ; and the fourth 
floor, in the form of a roof garden, fur- 
nishes outing space, sunshine and fresh 
air for the patients below and can be 
reached by means of an elevator from the 
wards. 

In the German Hospital in Chicago 
(Figs 76 and 77), which is of the L- 




FIG. 68. TOD WING, YOUNGSTOWN HOSPITAL, YOUNGSTOWN, OHIO. 
Edward F. Stevens, Architect. 



So 



THE AMERICAN HOSPITAL 



shape plan, the architects have designed 
the private and public wards in different 
sections of each floor, giving an excellent 
chance for segregation and treatment of 
diseases. In the public ward portion, six- 
bed wards are the largest. The placing 
of the elevator and staircase in a sepa- 
rate space, and grouping about these the 
utility rooms, must tend to minimize dis- 
turbance from the noises. Each floor is 
provided with two suites, with bath and 



lowed for storage, thus permitting sup- 
plies to be bought in quantity when mar- 
ket conditions are favorable. 

The ground floor contains a very com- 
plete out-patient department (see Chapter 
XI ) ; large locker rooms where all ward 
patients' clothing can be properly hung 
and systematically taken care of ; the ad- 
mitting department, already described ; 
the Roentgen-ray, psychopathic, isolation 
and medical treatment departments. 




FIG. 69. 



MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. 
Edward F. Stevens, Architect. 



toilet connecting, so arranged, however, 
that the waterclosets and bowls are sepa- 
rated from the tub, making it possible to 
use the suites as private rooms. The 
maternity and operating departments are 
on the fourth floor, with proper shut-offs 
and segregation of the noisy portions of 
the maternity department. 

In the Ottawa Civil Hospital, Ottawa, 
Canada (Figs. 78-86), the H-shaped 
building is designed to be administered 
as two units, right and left. On the so- 
called tunnel floor there is much space al- 



In the center of the first floor is the 
administration, the remainder being de- 
voted to wards. The second floor is re- 
served for women ward patients, 130 in 
all, in wards of three, five and six beds, 
or four-bed units in sixteen-bed wards. 
The five utility rooms save much time 
and travel for the nurses and facilitate 
service. Three nurses' stations command 
the whole area. There are two large serv- 
ing kitchens, two surgical dressing rooms, 
and a special isolation department for ve- 
nereal cases. 



OF THE TWENTIETH CENTURY 



57 



INFIIHAR.Y 



° 3 

feWACI) * 




fcCOf 



Second floojl Plan 

Icale ■ ■WWHijiUOiJ f Teet 



-Q- 



MATERN1TY pavilion 
Bridgeport Hospital 
Bridgeport Conn 

EDVMJLD f JtEVENJ ARCHITECT 
i>COTON MAii 



FIG. 70. MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL 
Edward F. Stevens, Architect. 



— 1 ' 

VENT EitV 




Et-VING 
ClTCHEM i 




IIIHII^i 





£OOF.:WA&.M 



loor 



LOOf 



Thild Jipoi. -Plan 



Maternity Pavilion 
Bridgeport Hospital 
Bridgeport Conn 

Edwaild F Steven .j AJLCnrmcr 
ftoiTON maw 



FIG. 71. MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. 
Edward F. Stevens, Architect. 



58 THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



59 




FIG. 74. PRIVATE ROOM, MATERNITY BUILDING, BRIDGEPORT (CONN.) HOSPITAL. 

Edward F. Stevens, Architect. 



60 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



61 



The third floor is the maternity depart- 
ment, wards and private rooms, with two 
delivery rooms, labor room and accesso- 
ries, two nurseries, and an isolation de- 
partment for infected cases. 

The fourth floor consists of wards for 
semi-private cases. The fifth, comprising 
seventy private rooms, has twelve pro- 
vided with baths, making especially flexi- 
ble units. There are very large balco- 



nies, and all doors throughout the hos- 
pital will admit of beds being moved in 
and out. On each floor there is space re- 
served for wheel chairs and stretchers. 

The sixth floor contains the operating 
department, and roof wards with all 
requisite utilities, located near the ele- 
vator. 

In the Notre Dame Hospital, Montreal 
(Figs. 87-92), the irregular H-shape of 




62 



THE AMERICAN HOSPITAL 



the building is due to the size and shape 
of the plot of ground. The considerable 
slope was made a reason for locating the 
entrances for ambulance cases and out- 
patients at the rear of the main part of 
the building. There is one admitting de- 
partment for both in and out patients, 
located here. 

On the ground floor (Rez de Chaussee) 
the right wing is devoted to the out-pa- 



tient department ; the center to the labo- 
ratories- — pathological, chemical and bac- 
teriological, and the autopsy; the left 
wing contains the medical treatment de- 
partment, the occupational therapy room, 
and two isolation departments, each self- 
contained. 

The first floor (ler Etage) is given 
up to wards, except the center administra- 
tion portion. The second floor (2me 



OF THE TWENTIETH CENTURY 



63 




FIG. 78. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albert Ewart, Associate. 



64 



THE AMERICAN HOSPITAL 




FIG. 79. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albert Ewart, Associate. 



OF THE TWENTIETH CENTURY 



65 




FIG. 80. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albert Ewart, Associate. 



66 



THE AMERICAN HOSPITAL 




FIG. 81. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albert Ewart, Associate. 



OF THE TWENTIETH CENTURY 



67 




FIG. 82. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architect l. J. Albert Ewart, Associate. 



68 



THE AMERICAN HOSPITAL 




FIG. 83. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albert Ewart, Associate. 



OF THE TWENTIETH CENTURY 



69 




FIG. 84. OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albeit Ewart, Associate. 



70 



THE AMERICAN HOSPITAL 




if ViFfff 



i ECtlOUl D I A q R. A J 



FIG. 



85. SECTION, OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. J. Albert Ewart, Associate. 



Etage) and the third (3me Etage) each 
contain three units of wards, the sixteen- 
bed wards being divided into four sec- 
tions (the Rigs design). There are many 
three and four bed wards, and a number 
of single rooms for seriously ill or dis- 
turbing cases. There are two large serv- 
ing kitchens (Office), three nurses' sta- 
tions (Garde Malade), a surgical dress- 
ing room (Pansements), and ample, eas- 
ily accessible balconies. The fourth and 
fifth floors, of sixty-five private rooms 
each, have similar utilities. 

The sixth floor contains the Roentgen- 
ray department, at the left, the remainder 
being the surgery, with four operating 
rooms, a plaster room, etc. 

All floors are planned so that the left 
wing can be built after the remainder of 
the hospital is in use. 

The Reid Memorial Hospital, Rich- 
mond, Ind (Figs. 93, 94, 95), shows an 
interesting unit added to an existing 
building. The first floor provides three- 
bed wards, double rooms and private 
rooms, totalling forty beds. There is a 
centrally-located nurses' station, a large 
serving kitchen, three utility rooms, a 
small room for flowers, a solarium, a cov- 
ered and an open balcony. The maternity 
and children's departments, on the second 
floor, are small but complete. An inter- 



esting feature is the roomy, enclosed am- 
bulance entrance. 

The main building of the Salem Hospi- 
tal, Salem, Mass. (Figs. 96, 97, 98, 98A), 
presents a good example of how all de- 
partments may be planned for under one 
roof. There is a complete administra- 
tion department, men's and women's med- 
ical and surgical, with provision for iso- 
lating venereal or other cases, a children's 
department, a maternity department with 
two delivery rooms and a separate section 
for private patients. There are extensive 
balconies. The utilities are well placed. 

The Ohio Valley General Hospital 
(Fig. 103) was built on one of the many 
hills of West Virginia, which made it 
necessary to utilize the various grades of 
the streets surrounding the site. An al- 
most precipitous cliff at the north deter- 
mined the outline of the north wing. 

The hospital is a block type, self-con- 
tained institution. It is planned to care 
for all departments of a general hospital 
— out-patients, accident, surgical, medical, 
maternity, children's, contagious — as well 
as for the segregation of colored patients. 
It is also provided with heating, lighting, 
and refrigerating plants, as well as a dis- 
tilling plant for distilling all the drinking 
water and that used in connection with the 
surgical departments. 



72 THE AMERICAN HOSPITAL 



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OF THE TWENTIETH CENTURY 



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74 



THE AMERICAN HOSPITAL 





-REID-MEMORIAL-HOJPITAL- 
RICHMOND * *■ INDIANA - 

Edward F./TEVEHy ■ Architect 
^ Park ,/theet 6o/ton Ma././ 



FIG. 93. 



In planning this institution, it was de- 
cided to have no wards larger than eight 
beds, as a better segregation of cases 
could be obtained than by using large 
wards. This being a general hospital, 
both private and charity cases are cared 
for. 

Provision is made on every floor for 
airing balconies (Fig. 104) so that all 
patients can be wheeled into the open 
when desired. A large roof ward is pro- 
vided on the upper story. 

The combining of the contagious de- 
partment (Fig. 102) with the general 
hospital within the same walls is prac- 
ticed here without any serious complica- 
tions or cross infections. 

The Macon Hospital (Fig. 106) like 
many another institution throughout the 



United States, found that its work was 
deficient on account of lack of better fa- 
cilities for the care of the sick ; additional 
land was secured in two different direc- 
tions and the development of the insti- 
tution has been attempted. The old build- 
ings, A, B, and C, have been remodelled 
and put into working condition. The 
ward unit in Building B has been rear- 
ranged on the "Rigs" type, providing for 
sixteen beds, with quiet rooms and utili- 
ties, while the old children's ward has 
been made into a modern serving kitchen. 
The old staircases and general partitions 
in A, B, and C have been largely retained, 
but the utilities have been enlarged. 

Pavilions D, E, and F are new. Pa- 
vilion D is practically for private patients 
and consists of private rooms and the 



76 



THE AMERICAN HOSPITAL 




FIG. 95. 

REID MEMORIAL HOSPITAL, RICHMOND, INDIANA 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



77 




OF THE TWENTIETH CENTURY 79 




80 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



81 




FIG. 99. OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 



general utilities. Pavilion F is designed 
for colored patients, who in southern sec- 
tions, of course, must be segregated from 
the white patients. The service building 
E contains the kitchen, dining-room, 
laundry, power plant, and garage, and is 
located centrally with respect to the whole 
group. 

The ground floor of the pavilion for 
negroes, F, is devoted to an out-patient 
department, which will be described in 
another chapter. 

The third floor of Pavilion D consists 
of children's and operating departments, 
which are described in their proper places. 
The roof ward (Fig. 109) is provided 
with ample facilities for out-door treat- 
ment, and is connected directly with the 
serving kitchen, elevator, and staircase. 

The Mansfield General Hospital, at 
Mansfield, O. (Fig. 110), is another ex- 
ample of the self-contained type, with all 
departments in one building. In this hos- 
pital the attempt has been made to segre- 



gate, so far as possible, the divisions of 
male, female, children's and maternity; 
and with the T-shape plan which is here 
adopted this was found to be a compara- 
tively easy problem to solve. A central 
serving kitchen serves all of the three 
different departments on each floor. A 
separate sink and toilet room, however, is 
provided in each unit. The nurses' sta- 
tion is located in the center, from which 
point it is possible to observe the three 
wings of the building. The main offices 
are located on the first floor ; and a small 
out-patient department, a medical treat- 
ment, Roentgen-ray department, the heat- 
ing plant and the kitchen plant are located 
on the ground floor. The contour of the 
site selected allows for good lighting in 
all departments. 

On the second floor (Fig. Ill) are lo- 
cated the maternity department and pri- 
vate rooms and suites; and shut off and 
isolated from the rest of the building is 
the operating department. The maternity 



82 



THE AMERICAN HOSPITAL 




^ FlR-ST FLOOR. PLAN 

FIG. 100. OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 

Edward F. Stevens, Architect. 




jcali. '. . . .t. .. r Four-th Floor. Plan 

FIG. 101. OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 




3cAtt fc » r Fifth Floor. Plan 

FIG. 102. OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 
Edward F. Stevens, Architect. 




FIG. 103. OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 
Edward F. Stevens, Architect. 



84 



THE AMERICAN HOSPITAL 




FIG. 10S. VIEW FROM REAR, SHOWING AIRING BALCONIES, OHIO VALLEY GENERAL 
HOSPITAL, WHEELING, W. VA. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



85 




FIG. 106. FIRST FLOOR PLAN. 



THE AMERICAN HOSPITAL 



a? 

O 




FIG. 107. MACON HOSPITAL, MACON, GA. 
Edward F. Stevens, Architect. Alexander Blair, Associate. 




o o 

■ e»Lt l_M_M.M \ i z^i^mm^t' let 

FIG. 108. MACON HOSPITAL, MACON, GA. 
Edward F. Stevens, Architect. Alexander Blair, Associate. 



OF THE TWENTIETH CENTURY 



87 




TouaTft fxoojt e Jloop -Plan I'l l 
yc«i.t lm-M ■ ti ■iVnT 

FIG. 109. MACON HOSPITAL, MACON, GA. 
Edward F. Stevens, Architect. Alexander Blair, Associate. 



delivery room is placed within the operat- 
ing section, making it possible to utilize 
the sterilizing room, the doctors' waiting- 
room, and the other equipment of the 
operating department in connection with 
the obstetrical work. 

In the Illinois Central R. R. Hospital, 
Chicago, the ward unit is somewhat un- 
usual, as there are no large wards. The 
greatest number of beds in any ward is 
four, while the majority of the rooms are 
for individual patients. 

Like some of the other hospitals de- 
scribed, the basement and first floor are 
devoted to administration and medical 
treatment, and there are no patients' 
rooms below the second floor. The 
entrance lobby is large and generous, 
giving the would-be patient the idea of 
hospitality. 

On the first floor (Fig. 112), besides 
the general office, reception rooms, etc., 
are located the laboratory, the hydro- 
therapeutic, Zander room, and X-ray 
room, together with rest room, toilets, 
etc., for the medical treatment depart- 
ment. On this floor is also located a 
small out-patient department, with wait- 
ing and treatment rooms ; also rooms for 
the internes and chief surgeon. 



The kitchen, scullery, diet kitchen, dis- 
infecting room, mortuary, etc., are lo- 
cated in the basement. 

The ward utilities are sufficiently iso- 
lated from the public corridor. The ele- 
vator and staircase-hall are placed in a 
separate tower. 

On the third floor (Fig. 113) is located 
the operating suite, consisting of three 
operating rooms, nurses' work room, 
sterilizing room, anaesthetizing room, 
utility room, and surgeons' locker room, 
the surgeons' scrub-up being placed at 
the end of the main operating corridor. 
Built-in cabinets, blanket warmers, etc., 
make this a most complete unit. 

The heating plant and laundry are in 
an entirely separate building. 

The demand for a private ward unit in 
Canada's great hospital, the Royal Vic- 
toria, in Montreal, has been so great that 
one of her most generous-hearted sons 
has provided the means for building a 
complete and thoroughly equipped pri- 
vate patient pavilion for this institution 
(Figs. 114-118). 

The general plan (Fig. 11) shows the 
location in connection with the existing 
hospital. It has been necessary to plan 
with precipitous grades, and the approach 



ss 



THE AMERICAN HOSPITAL 




FIG. 110. 



to this pavilion from the main hospital 
is over a bridge from the second story 
of the original building; thence through 
the tunnel into the mountain; thence, by- 
means of elevators and staircases, to the 
various floors of the new pavilion. 

While every institution should have its 
entrance speak "Welcome" to the coming 
guest, it is doubly important in a building 
of this kind that much care be devoted to 
making an entrance commensurate with 
the object for which the building is erect- 
ed. The severe hygienic detail which it 
is desirable to use where surgery and sur- 
gical dressings are under way can be 
abandoned here and the aesthetic side 
considered. While the question of hy- 
giene should never be lost sight of in any 



hospital department, the hospital architect 
should not be a slave to this fancy, but 
should be able to couple good hygiene 
with good design. 

The medical treatment department 
(Fig. 142) of this building is as complete 
as that of any of its kind in America, for 
the authorities of the hospital realized 
that the physician should have greater op- 
portunities for his work than are pro- 
vided in the majority of medical institu- 
tions. 

The surgical department (Fig. 116) is 
most complete. The system of lighting 
is entirely indirect, no lighting fixture be- 
ing in the operating room, but all con- 
cealed behind the glazed ceiling. 

Entirely new models of sterilizers were 



OF THE TWENTIETH CENTURY 



89 




FIG. 



111. MANSFIELD GENERAL HOSPITAL, MANSFIELD, O. SECOND FLOOR PLAN. 

Vernon Redding, Architect. Edward F. Stevens, Consultant. 



designed for this building. Distilled wa- 
ter for drinking purposes is provided on 
all floors. 

A series of balconies from private 
rooms is arranged on all sides of the 
building, making it possible for the pa- 
tients to have their own private balconies, 
just as they have their own baths and toil- 
ets. Additional airing balconies for every 
floor are provided. 

Much of the equipment for Roentgen 
ray department was especially designed 
for this building. 

Every room has double doors, and all 
partitions are double, so that one patient 
shall not disturb another. Each room 
has its telephone. There are thirty rooms 
with connecting baths. On the ground 
floor is a sitting room and a dressing 
room for special nurses. 

The American Memorial Hospital 
(Figs. 119, 119Aand 119B),tobe built at 



Rheims, France, will provide for about 
one hundred beds, with both wards and 
private rooms. The large wards are di- 
vided into two-bed cubicles, thus securing 
a degree of privacy. There are large 
porches. The operating department is in 
its own separate corridor. There are 
good X-ray and laboratory departments. 

As a large part of the smaller hospitals 
today are being maintained by one or an- 
other religious society, it very often fol- 
lows that the provision for a chapel must 
be incorporated into the plans of the 
institution. In the larger institutions, 
this is provided for by a separate building 
more or less isolated from the hospital 
group, but in the smaller institutions it is 
often considered advisable to have this 
chapel within the walls of the institution. 
A practical carrying out of this idea is 
shown in the plans of the St. Joseph's 
Hospital of Hamilton, Ontario (Figs. 



OF THE TWENTIETH CENTURY 



91 




94 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



95 




96 THE AMERICAN HOSPITAL 




98 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 




FIG. 119-B. THIRD FLOOR PLAN, AMERICAN MEMORIAL HOSPITAL, RHEIMS, FRANCE. 
Butler & Rodman, Auguste Pellechet, Associated Architects. 



119D, 119E, 119F, 119G, and 119H. In 
this surgical building, the ground floor 
was devoted, as in many other examples, 
to the kitchen, dining rooms, demonstra- 
tion, classroom and Roentgen-ray Depart- 
ment. On the first floor at either end of 
the pavilion are the wards for male and 



female, together with the service rooms, 
staircase, etc. In the crossing of the 
main corridor the chapel is located 
directly over the kitchen. The second 
story of this simple plan is devoted to 
private rooms and the Operating De- 
partment. 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 




FIG. 119-E. FIRST FLOOR PLAN, ST. JOSEPH'S HOSPITAL, SHOWING CHAPEL, 

HAMILTON, ONT. 
Stevens & Lee, Architects. 



102 



THE AMERICAN HOSPITAL 




FIG. 119- F. SECOND FLOOR PLAN, ST. JOSEPH'S HOSPITAL, HAMILTON, ONT. 
Stevens & Lee, Architects. 




104 



THE AMERICAN HOSPITAL 



CHAPTER IV. 

l^fje Surgical department 



In American hospitals, the surgical or 
operating unit takes a greater variety of 
forms than does the ward unit. It is 
probable that no one can say with author- 
ity that this or that is the ideal arrange- 
ment for this important part of the hos- 
pital. We cannot take as our model any 
of the European operating building plans, 
since conditions there are vastly different. 
In the German government hospitals, one 
surgeon will do the majority of the op- 
erations and naturally will need but one 
or two rooms. In our own hospitals, 
with the large staffs in even those of only 
one hundred beds, it is not uncommon to 
find five or six operations going on at 
once. 

In illustration of this point there may 
be given a few notable examples. The 
Virchow at Berlin, with its two thousand 
patients, a large percentage of whom are 
surgical, has but four operating rooms, 
one of them for known septic cases. In 
the Munich-Schwabing, with one thousand 
beds, there is but one for clean operations. 
In this country, on the other hand, we 
find in many comparatively small hos- 
pitals a very large proportion of operat- 
ing rooms. In the Massachusetts Gen- 
eral Hospital (Fig. 120), with two hun- 
dred and fifty beds, there are five oper- 
ating rooms, besides those in the accident 
and orthopedic department. The Grace 
Hospital at Detroit (Fig. 123), with two 
hundred patients, has four operating 
rooms, besides surgical dressing rooms, 
where minor operations are sometimes 
performed. In the Youngstown Hos- 
pital, with one hundred and fifty beds, 
four operating and two accident rooms 
were needed. The Peter Bent Brigham 
Hospital, with two hundred and twenty- 
five beds, has three operating rooms. The 
Bridgeport hospital, with two hundred 
beds, has three operating rooms. 

Our construction is governed largely 
by the methods of the local surgeons who 
are to work in any given building. Every 
year there come new methods in operat- 



ing, affecting everything from the an- 
esthesia of the patient to his recovery. 
A building planned to meet the require- 
ments of today may therefore, when fin- 
ished eighteen months hence, be found 
lacking in some essential detail. Thus it 
is that the up-to-the-minute operating 
unit is well-nigh impossible to obtain. 

The operating department should, 
where possible, be isolated. A separate 
building is the ideal arrangement. Where 
this is not possible, the upper story (if 
there is elevator service) should be used 
and the department well separated from 
other rooms. 

If the operating department is in a 
separate building, there should be an ad- 
mitting room at the ambulance entrance, 
closely connected with the accident room 
which should have good north light. 
These rooms should not connect with 
anything except the corridor. This ac- 
cident room can also be used for septic 
cases. 

The day of the amphitheatre in the 
modern hospital, as an operating unit for 
teaching, seems to have gone While the 
amphitheatre is used, of course, for teach- 
ing in clinics and lectures, the majority 
of surgeons have come to the conclusion 
that in order to gain an intimate knowl- 
edge of live tissue the student must be 
very close to the patient under operation, 
and smaller and more numerous classes 
are formed. 

For the ordinary operating room an 
area of 300 square feet, or a room about 
16 by 20 feet, will very well suffice. All 
the actual work is concentrated about the 
operating table, and any space beyond that 
needed for the surgeons' and nurses' work 
and for the necessary equipment is more 
or less wasted. If observation stands or 
balconies are used, the area of the operat- 
ing room should be increased to accom- 
modate them. ( See the Geisinger operat- 
ing building, Fig. 57.) 

The major operating room should have 
no plumbing or other attached fixtures, 



OF THE TWENTIETH CENTURY 



105 




FIG. 120. OPERATING DEPARTMENT, MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MASS. 

Wheelwright & Haven, Architects. 



except perhaps a flushing floor drain and 
a sterile water outlet. A small electric 
instrument sterilizer may be thought de- 
sirable, but with the sterilizing room 
close at hand this is not necessary. 

The heating of the operating room 
should be sufficient for any desired tem- 
perature within reason. Fresh air 



should be introduced to make the room 
comfortable to work in. This can be ac- 
complished in various ways — by the 
plenum system, where the air is heated 
and blown in by fans; by gravity, with 
screens to prevent air from being fouled 
by dust; and by direct-indirect, with 
proper air inlets carefully screened. 




FIG. 121. OPERATING UNIT, ST. GEORG FIG. 122. OPERATING UNIT SECTION OF 

HOSPITAL, HAMBURG, GERMANY. ST. GEORG HOSPITAL, HAMBURG 

GERMANY. 



106 



THE AMERICAN HOSPITAL 




1 



! fN*ESTHE.T IC. 
R.' M 




FIG. 123. OPERATING DEPARTMENT, GRACE HOSPITAL, 
DETROIT, MICH. 
Edward F. Stevens, Architect. 




There can be no objection to direct heat, 
provided the heating units are readily ac- 
cessible for cleaning, and provided fresh 
air can in some way be introduced. But 
the rooms used for operating, sterilizing, 
and anesthetizing must be well ventilated 
always. (See Chapter XVI, "Heating 
and Ventilation.") 

The lighting of the operating room 
needs careful study, both for day and 
for night. For the day, large vertical 
windows and skylight, facing toward 
the north or as near the north as possible, 
are best. By carrying the vertical 
window sufficiently high, practically the 



same results without skylights are ob- 
tained so far as light is concerned — e. g., 
Macon, Cable Memorial and Williams 
Hospitals. The glazing, in cold climates, 
should be double, or with a glass screen 
as at the Jefferson in Philadelphia, the 
Bridgeport at Bridgeport, the Royal Vic- 
toria at Montreal, etc. The skylight 
windows may have rolling shades be- 
tween the two panes of glass in case the 
light is too strong. 

There is much to be said in regard to 
artificial lighting. The crane light has 
been used successfully, having the ad- 
vantage of a direct and powerful light 



108 



THE AMERICAN HOSPITAL 




FIG. 126. OPERATING ROOM, QUINCY CITY HOSPITAL, QUINCY, MASS., SHOWING GLASS 
SLIDE OVER INSTRUMENT STERILIZER. 



OF THE TWENTIETH CENTURY 



109 




FIG. 127. OPERATING ROOM, OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 

Edward F. Stevens, Architect. 



when needed and of being swung away 
easily when not wanted. (See Artificial 
Lighting, Chapter XVII.) 

Reflected light from a high power lan- 
tern outside the operating room, with 
fixed reflecting mirrors, has been used 
with much success. Trouble, however, 
has been experienced through the vibra- 
tion of the building, which changed the 
adjustment. 

Reflected lights from numerous fix- 
tures, either with direct reflectors or dif- 
fused from the ceiling, have been very 
successful. 

Daylight effect is very desirable in the 
operating room. There are different 
lamps and combinations with occasional 
improvements. The best of today ap- 
pears to be from high power nitrogen 
lamps above the ceiling diffused by inter- 
vening glass of proper quality. 

One can hardly name the best floor for 
an operating room. There are many good 
materials, such as non-absorbent marble, 
vitreous tile, terrazzo, and even cement 
if treated with a non-dusting prepara- 
tion. 



The walls of the operating room should 
either be lined with marble or tile, or 
finished in hard plaster and thoroughly 
enamelled. It must be possible to scrub 
thoroughly or spray with water or steam 
the entire surface of the walls and floor. 
To this end, a floor drain of proper con- 
struction should be supplied. (See 
Chapter XVI, "Plumbing.") 

It has been found that a clear white 
tile on floor and walls is too glaring in 
the intense light of the operating rooms ; 
and gray, buff, and even green have been 
used with success. Gray Tennessee mar- 
ble is very satisfactory. Some surgeons 
have insisted upon having the lower por- 
tion of the walls a dark shade of gray, 
green or even black, the sheets and towels 
which cover the patient and the gowns of 
doctors and nurses being of a similar 
color. It is the writer's usual practice to 
make the upper portion of the walls a 
light buff, not far from the color of 
manila paper, and the lower portion a 
little darker ; this has proved acceptable 
to some of the leading surgeons. 

Next in importance to the operating 



112 



THE AMERICAN HOSPITAL 




room is the sterilising room. This need 
not be large, but should be specially ven- 
tilated ; all exhaust steam pipes should 
be extended into the open air; and if a 
hood can be placed over the sterilizer, it 
should be done. It is advisable to place 
the water sterilizers or still at an eleva- 
tion, so that the sterile water may flow to 
each operating room and, by the use of 
reheaters, be heated by steam or elec- 
tricity. Such reheaters should be pro- 
vided with elbow control valve and the 
discharge nozzle protected from contact 
by a metal or glass hood. A proper re- 
ceptacle, like a porcelain sink, properly 
trapped, should be placed under the re- 
heater. 

The nurses' zvorkroom should be large 
enough for the corps of nurses needed, 
should be provided with tables for mak- 
ing up dressings, with sinks, slabs for 
cleaning instruments, special scrub-up 
bowls for the clean nurses, cabinets for 
sterile and unsterile dressings, etc. 

The small laboratory for quick diag- 
noses is considered a necessary part of 
the operating suite. It should be well 
provided with apparatus for making 
rapid microscopic examinations of tissue 
while the patient is still on the table. 

There should be a surgeons' room or 
rooms, of sufficient size, supplied with a 



locker for each surgeon, comfortable fur- 
niture, shower bath and toilet. The in- 
strument room may have a locker or com- 
partment for each surgeon's instruments. 
Anaesthetizing rooms, well ventilated, 
should be sufficiently screened from the 
operating corridor, yet near the operating 
rooms, and should have doors of ample 
width to admit a bed, with jambs and 
doors protected by metal. 

The scrub-up sinks should be either in 
the corridor or in an open alcove without 
doors near the operating room where 
there will be plenty of room for all to 
work without interference, and with 
plenty of shelf room for soap, brushes, etc. 

The details of finish and equipment, 
the plumbing and heating of the operat- 
ing suite will be taken up in later chap- 
ters. 

The operating department of the St. 
Georg Hospital (Fig. 121) at Hamburg 
is one of the most carefully worked out, 
so far as hygienic detail is concerned. 
Strict attention is given to the heating 
and ventilation (Fig. 122) ; the air is 
washed and filtered before entering the 
room, and the direct heating units are en- 
tirely outside the walls. The equipment 
is most carefully designed. 

In the operating department of Grace 
Hospital, Detroit (Fig. 123), there are 



OF THE TWENTIETH CENTURY 



113 



three rooms for clean surgery, besides 
the septic, surgical dressing, and plaster 
rooms. The surgeons' locker and dress- 
ing rooms are outside the clean portion 
of the department. Here the room for 
scrubbing up is not connected with the 
locker room. There is a large sterilizing 
room and a larger room for the nurses' 
work of preparation ; also an instrument 
room where each surgeon has his own 
compartment in the instrument case, etc. 

The operating building of the Youngs- 
town Hospital (Fig. 124), Youngstown, 
O., is two stories in height, and is divided 
into two sections — the accident and the 
operating proper. The accident depart- 
ment, on the ground floor, gives access 
for ambulance patients ; the elevator 
reaching the first floor level. On the 
ground floor are the receiving and wait- 
ing rooms, the two accident rooms, labor- 
atories, morgue and store rooms. On the 
first floor are the operating rooms, with 
two anesthetizing rooms, which are placed 
in the center of the building, with sky- 



lights, and are entered either from the 
main corridor or from the operating cor- 
ridor. This makes it unnecessary for the 
patient to enter the operating corridor 
until anesthetized. The three clean oper- 
ating rooms open from a ten-foot corri- 
dor, in which are the surgeons' scrub-up 
bowls, so placed that six men may scrub 
at once. A septic operating room is pro- 
vided, a large sterilizing room, a large 
work room for nurses, instrument room 
and a small laboratory. 

Sterile water is brought from a cen- 
tral apparatus to each operating and ac- 
cident room, and there heated locally by 
electricity. 

The Quincy City Hospital (Figs. 125 
and 126), Quincy, Mass., is a small in- 
stitution with a capacity for fifty beds, 
but its operating department is in a sepa- 
rate building. In this, all the essentials 
have been provided. The accident and 
Roentgen-ray rooms and surgeons' room 
are removed from the clean corridor, 

At the Ohio Valley General Hospital 




FIG. 



131. OPERATING DEPARTMENT, NEW YORK CITY HOSPITAL, NEW YORK, N. Y. 
Charles B. Meyers, New York, and Edward F. Stevens, Boston, Architects. 



114 



THE AMERICAN HOSPITAL 




/econd Floor, Plan 

O 6 it ML. 

fcAiirmrw m ■ zzzzwm^— telt 



FIG. 132. OPERATING DEPARTMENT, BRIDGEPORT HOSPITAL, BRIDGEPORT, CONN. 

Edward F. Stevens, Architect. 



one wing of the fifth floor is set apart 
for the operating department, with one 
septic and two clean operating rooms 
(Fig. 102). The scrub-up basins are 
placed in the center of an open cross cor- 
ridor, accessible from all sides. Steriliz- 
ing room, nurses' work room, surgeons' 
and anesthetizing rooms are placed con- 
veniently for service. Distilled water 
from a supply tank in the tower fur- 
nishes sterile water for the operating, 
accident, maternity, and laboratory de- 
partments. 

The operating pavilion of the Cincin- 
nati General Hospital (Figs. 128 and 129) 
is most complete, each operating unit 
having its own anesthetic room adjoin- 
ing and recovery room close at hand. 
The necessary nurses' work rooms, 
dressing, instrument, and laboratory 
rooms are provided. 

The lecture amphitheatre, while in the 



same building, is not directly connected, 
but is reached through the lower level 
and approached by two elevators and 
staircases. 

In the private patients' building of the 
Buffalo General Hospital, Buffalo, N. Y. 
(Fig. 53), there are two major operating 
rooms, each with an anesthetizing room 
adjoining; the sterilizing room is between 
them. The nurses' work room and a 
minor or eye operating room open off 
the same corridor, in the ample space of 
which are the surgeons' scrub-up sinks. 
A plaster room, the surgeons' rcom and 
the nurses' locker room open from an 
adjacent corridor. The instrument cab- 
inets are built into the construction. 

In the operating building of the George 
F. Geisinger Memorial Hospital, Danville, 
Pa. (Fig. 57), the rooms are grouped 
about an octagonal rotunda, in the center 
of which is the surgeons' scrub-up, form- 



OF THE TWENTIETH CENTURY 



115 



ing a decorative feature. The walls of the 
rotunda are of marble, with cases for the 
in truments set into niches on four sides. 
There are three operating rooms, one of 
which can be darkened for eye work. The 
observation stands in these rooms are ap- 
proached from separate corridors, making 
it unnecessary for students or visitors to 
pass through the operating room. A win- 
dow from this special corridor also per- 
mits observation from that point. Each 
operating room has its heating unit ves- 
tibuled between the inner and outer win- 
dow sashes. In these same vestibules are 
refrigerating pipes for reducing the tem- 
perature in summer. 

The sterilizing room for instruments 
and utensils opens directly into the two 
operating rooms ; a separate sterilizing 
room for dressings is provided. Distilled 
water is piped to each operating room. 
There is a small laboratory and ample 



storage space for linen and supplies. The 
admitting room for accident cases is lo- 
cated near this department. 

It will be observed that doors have been 
dispensed with throughout the department 
wherever possible. 

In the Ottawa Civic Hospital, Ottawa, 
Canada (Fig. 84), the surgical depart- 
ment occupies practically the whole of the 
sixth floor. There are four major operat- 
ing room; and one for eye work. The 
sterilizing room is in two sections, for 
facility of service; the instrument room 
is directly off the instrument sterilizing 
room. There is a separate room for plas- 
ter work, and a large work room. Special 
features are the separate dressing rooms 
for the house and attending staff, as well 
as the one for the nurses. There is a 
waiting room for the relatives of patients. 

In the Notre Dame Hospital, Montreal 
(Fig. 92 ), there are two major operating 




FIG. 133. BUILT-IN CASES, OPERATING DEPARTMENT, BRIDGEPORT HOSPITAL, 

BRIDGEPORT, CONN. 
Edward F. Stevens, Architect. 



116 



THE AMERICAN HOSPITAL 



rooms with a sterilizing room between Remodelled Operating Departments. It 
them, an eye operating room, and a plas- is quite common, in modernizing an old 
ter room. The scrub-up is in the rotunda, hospital, for the provision for the operat- 
and around this rotunda centers the ing department to be somewhat limited ; 
service. There are three anesthetizing and it is not an unusual thing for the attic- 
rooms, near the elevator, opening on a story, which has been used as kitchen or 
special corridor. The surgeons' room is servants' quarters, to be turned over to 
at the left of the staircase ; there is a large the architect to make into a modern oper- 
work room, ample storage space for ating department. Two or three ex- 
made-up supplies, a dressing room for the amples of this may be helpful, 
nurses, and a small emergency laboratory. In the Rhode Island General Hospital 
In the Hamot Hospital, Erie, Pa. (Fig. (Fig. 130), at Providence, an unused 
50), nearly the whole of the top floor is upper story was utilized, providing five 
devoted to the operating department. The good operating rooms, and all the con- 
two larger operating rooms are on their veniences of a modern surgical unit, 
own corridor. The delivery room is situ- In the A r czv York City Hospital 
ated here, also a room for plaster work. (Fig. 131), Blackwell's Island, the dome 
There is a sink room and serving kitchen of the old building, formerly used as a 
next the roof garden, so that it may kitchen, was so reconstructed as to meet 
be used for the outdoor treatment of the needs of the surgeons. The struc- 
cases which require it. tures of the roof trusses made the plan- 
In the Reid Memorial Hospital, Rich- ning more difficult, and the spaces which 
mond, Ind. (Fig. 94), all the rooms of would in an ordinary case be used as op- 
the operating department are arranged perating rooms were very conveniently 
about a central rotunda, thus giving quick turned into nurses' and students' locker 
service, no matter what the combination rooms and entrance to student's gallery 
of events. (in no sense an amphitheatre). Sky- 




FIG. 134. MAJOR OPERATING ROOM, BRIDGEPORT HOSPITAL, BRIDGEPORT, CONN. 

Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



117 




FIG. 135. OPERATING ROOM, DR. WILLIAMS' PRIVATE SANATORIUM, MACON, GA. 



lighting of all rooms was practically 
necessary. Four operating rooms are 
provided, only two of which could have 
the north exposure. Here again dis- 
tilled water is made at an elevation, and 
conducted to the various rooms. 

At the Bridgeport Hospital (Fig. 132) 
the case was slightly different. An old 
operating theatre, with a small addition, 



was turned into three modern operating 
rooms, with sterilizing, instrument and 
work rooms. Entrance for students to 
the major operating room was secured hy 
a gallery from the main corridor. 

Built-in cabinets (Fig. 133), distilled 
water reheaters, and specially designed 
equipment make this a very complete 
department. 




FIG. 136. MAJOR OPERATING ROOM, BARRE CITY HOSPITAL, BARRE VT. 
Edward F_ Stevens, Architect. 



OF THE TWENTIETH CENTURY 



119 



CHAPTER V. 



Jilebtcal treatment department 



The fact is recognized more and more 
every year that many diseases and ail- 
ments which have hitherto been consid- 
ered surgical cases or which have been 
neglected altogether can now be treated 
without surgery and with little medicine. 
The medical treatment or bath depart- 
ment, as it is called in European coun- 
tries, is gradually being introduced into 
the general hospital plan. The hospital 
boards in this country have given little 
thought to this department, but in the 
larger European hospitals one will find 
the medical units with such sections as 

Mechano-therapy. 
Hot air baths. 
Warm air baths. 
Steam baths. 
Light baths. 
Electric baths. 
Gas baths. 
Radium baths. 
Sand baths. 
Sulphur baths. 
Mud or peat baths. 
Sun baths. 

Inhaling and pneumatic chambers. 
Roentgen-ray treatment. 

Today a careful student of hospital 
architecture will not dare to plan for a 
complete layout without providing facili- 
ties for some medical treatment, if it is 
nothing more than a few electric-light 
bakers. It may include hydrotherapeutic 
apparatus of various sorts, facilities for 
giving electric current or electric light 
treatments, massage, mechano-therapy, 
(gymnasium or Zander), X-ray treat- 
ments, etc. We should no longer give to 
I he surgeon and the obstetrician all the 
best rooms of our hospitals, but should 
provide space for the present and the 
future for internal medicine and ther- 
apeutics. 

To the student of hospital architecture 
the question naturally arises: If these 
methods of treatment are essential for 



the well-being of the poor and indigent 
across the sea, why should we not prac- 
tice them, or some of them at least, in 
our institutions? 

The hydro-electric bath, the carbon di- 
oxide bath, the plunge, and those previ- 
ously mentioned, are but a few of the 
examples one will find in the general pub- 
lic hospitals of Europe. Reference is 
not made to the various sanatoriums one 
finds over all the world, but to the gen- 
eral hospitals for the care of the poor 
and indigent. Should we not, in Amer- 
ica, provide such equipment that the pa- 
tient suffering from arthritis, chronic 
rheumatism, or cellulitis, let us say, may 
have the proper mechanical, electrical, 
heat and massage treatment, or the water- 
bed for severe bodily burns or sores? 

It is not necessary to have a five-thou- 
sand dollar, complete hydro-therapeutic 
outfit; but room can be secured in every 
hospital for a small equipment — an elec- 
tric baker, massage table, small vapor 
bath, etc. — and many simple home-made 
devices can be brought into use, if the 
medical student of today will only pre- 
pare himself to use them when he conies 
to be on the hospital staff of the future. 

Heat is an important therapeutic agent, 
whether it is applied by warm air, steam, 
electric light, or natural sunlight ; scien- 
tifically applied, it is a recognized medium 
for benefiting man's ills. 

If heat applied by the direct rays of an 
arc light has a higher therapeutic value 
than when applied by any other method, 
then this should be recognized and the 
equipment supplied. If the hot air bath 
will relieve pain when nothing else will, 
then this should be recognized. As the 
study of non-surgical methods for re- 
lieving suffering advances, hospitals 
should be prepared to provide the proper 
treatment. 

The airing balcony provides sunlight 
for the medical as well as for the sur- 
gical patient. The simplest, and many 
times the most potent agency, sunlight, 



120 



THE AMERICAN HOSPITAL 



can easily be provided in every institution. 

In discussion with various medical 
specialists, they have acknowledged the 
value of equipment and recommend it 
where possible, especially the full-length 
continuous bath or water-bed, the hydro- 
therapy and baking. In designing a new 
hospital there should be set apart certain 
rooms to be reserved for medical treat- 
ment rooms, for within a very short time 
the medical men will demand more equip- 
ment. 

The help given by scientific treatment 
to the so-called chronic invalids in some 
of the medical departments of the newer 
hospitals is referred to as little shoit of 
miraculous. 



To illustrate what some of the later 
European hospitals are doing in the line 
of medical equipment, a few examples 
are here shown. 

The Virchow, at Berlin, devotes even 
more room to the medical treatment de- 
partment than to the surgical. 

At the Barmbeck, Ruppel's latest hos- 
pital, at Hamburg, the bathhouse is given 
the place of honor on the main axis, while 
the operating pavilion occupies a second- 
ary position. 

The Bispebjerg, at Copenhagen, among 
the newest large Scandinavian hospitals, 
has devoted a large space to this depart- 
ment, which is entered by semi-under- 
ground passages. 




1. Roentgen therapeutics. 

2. Physicians' room. 

3. Dark room 

4. Light shaft. 

5. Photograph laboratory. 

6. Roentgen room. 

7. Undressing room. 

8. Waiting room. 

9. Attendants' room. 

10. Elevator. 

11. Social room. 

12. Ante-room. 

13. Segregated room. 

14. Light bath. 



15. Wash room. 

16. Toilet. 

17. Rest room. 

18. Pneumatic room. 

19. Examination room. 

20. Physicians' room. 

21. Ante-room. 

22. Douche room. 

23. Hot air bath. 

24. Warm air bath. 

25. Vapor room. 

26. Fango mud bath. 

27. Mud bath. 

28. Heat bath. 



29. Four-cell bath. 

30. Electric water bath. 

31. Gas bath. 

32. Salt water bath. 

33. Sand bath. 

34. Sand room. 

35. Sulphur bath. 

36. Female attendants' room. 

37. Therapeutic gymnastics. 

38. Masage room. 

39. Rest room. 

40. Hallway. 



FIG. 137. GROUND FLOOR PLAN, MEDICAL TREATMENT BUILDING, MUNICH-SCHWABING 
HOSPITAL, MUNICH, GERMANY. 
Richard Schachner, Architect. 



OF THE TWENTIETH CENTURY 





FIG. 138. PNEUMATIC CHAMBER, PLAN AND SECTION. 



122 



THE AMERICAN HOSPITAL 



In Munich- Schwabing, one of Europe's 
best hospitals, one finds a most complete 
equipment. If we study this plan in de- 
tail (Fig. 137), we find baths of every 
kind for the relief of suffering humanity. 
Commencing at the left are the Roentgen- 
ray department, the inhalation depart- 




FIG. 139. WATER BED. 



ment, the rest rooms, pneumatic chamber, 
massage and mechano-therapy ; and in the 
center are arranged the various baths — 
the Fango or Italian volcanic earth bath, 
the mud or peat bath, sand baths where 
the sand is heated and applied to the pa- 
tient, the CO 2 bath, the light bath, and 
the general hydro-therapeutic room with 
its spray baths of every description, its 
warm and cold plunge, and its wading 
bath. 

On the second story of this building 
is the great sun-bath, so arranged that if 
the sun is too warm the surface of the 
glass can be covered by a water curtain, 
thus reducing the temperature of the 
room. 

In this hospital the writer first saw 
the pneumatic chamber used for treat- 
ment (Fig. 138). A patient needing rari- 
fied air and sent to the hospital is placed 
in one of these rooms, surrounded by his 
books and papers; pressure in the room 
is reduced to the prescription amount and 
he is getting the rarified air of the high 
mountains at home. Perhaps he may be 
ordered a greater than atmospheric pres- 
sure, in which case the chamber is put 
under pressure instead of suction. 

The water bed, or continuous bath 



( Fig. 139), is used for the relief of man) 
troubles, notably extensive burns, some 
skin diseases, and mania, and is consid- 
ered one of the indispensable pieces of 
equipment. At the St. Georg the writer 
saw one poor fellow in the water-bed 
which he had occupied for months, eating, 
sleeping and reading, who could not have 
lived under other conditions. One will 
see this water-bed, or full-length tub with 
adjustable hammock, in many wards in 
Europe. In one hospital that the writer 
visited each medical ward had its water- 
bed, and in other wards each bed was 
provided with pipes from the wall, for 
cold water circulation in place of ice caps. 

The sand bath (Fig. 140), where the 
patient is packed in sterile sand at the 
proper temperature, is found in almost 
every large European hospital. 

There are few hospitals in the world, 
however, which have a more complete 
mechano-therapy equipment than the 
Massachusetts General Hospital, Bos- 
ton, with its splendid Zander room (Fig. 
141 ) . But even here the service is largely 
that of the surgical side. 




FIG. 140. SAND BATH. 



OF THE TWENTIETH CENTURY 



123 




FIG. 142. 



124 



THE AMERICAN HOSPITAL 



In the St. Luke's Hospital (Fig. 30), 
at Jacksonville, about one-half of the sec- 
ond story of the administration building 
is set apart for medical treatment. This 
portion is not equipped, but is ready 
whenever the demand comes and the 
funds necessary to equip and maintain it 
are obtained. 

In the Ross Private Pavilion of the 
Royal Victoria Hospital (Fig. 114) a 
large section is set apart and equipped 
for medical treatment, consising of a 
small psychopathic department, Roent- 
gen-ray department, hydro-therapy, elec- 
tric Nauheim, and continuous baths, rest, 
and massage rooms. 

The medical treatment department of 
the Ottawa Civic Hospital, 
Ottawa, Canada (Fig. 79), is 
not elaborate, but is fairly 
complete. It has rooms for 
special tub baths, showers, 
sprays and douches, packs, 
massage, etc. There are 



comfortable rest and dressing rooms. 

In the Cook County, Chicago, Psycho- 
pathic building (Fig. 228), there is a 
good hydro-therapeutic department, with 
arrangements for continuous baths, packs, 
etc. Rest rooms are provided. Theie is 
also a room for surgical dressings here. 

The Southern Pacific and the San 
Francisco County (Fig. 143) Hospitals, 
both at San Francisco, not only have very 
complete medical equipment but are using 
it constantly with the best results. 

Preventive medicine and treatment are 
much discussed. Why should not the 
medical treatment or bath-house depart- 
ment, with its many treatment and rest 
rooms, soon be as important a factor in 






J3 ® !®J 



© 



- rfBlflMTrinr 



FIG. 143. MEDICAL TREATMENT DEPARTMENT, 
SAN FRANCISCO HOSPITAL, SAN 
FRANCISCO, CAL. 

1. Mechanical apparatus. 

2. Plunge bath. 

3. Pump room. 

4. Toilet. 



5. Irrigation room. 

6. Douche room. 

7. Steam room. 

8. Toilet. 



Courtesy "The Modern Hospital" 

FIG. 144. BASKET ROOM, PHIPPS PSYCHIATRIC CLINIC, 
JOHNS HOPKINS HOSPITAL, BALTIMORE, MD. 

our hospitals as our operating depart- 
ment is today? 

The Department of Occupational The- 
rapy * Departments of occupational the- 
rapy are now being established in san- 
itoria, psychopathic hospitals, and also in 
general hospitals. Certain facilities are 
necessary for them to operate success- 
fully. 

There will always be some work done 
by bed-patients and some by up-patients. 
For the bed-patients, there should be stor- 
age space for materials and unfinished 
work near the wards in which they are ; a 
shelf in the linen closet may be sufficient. 

Up-patients usually prefer to go to a 
special occupation room. This should, 

*The author is indebted for this material to Minnie 
Goodnow, R. N. 




9. Dressing rooms. 

10. Lounge room. 

11. Hall. 

12. Store room. 

13. Toilet. 

14. Closet. 

15. Office. 



OF THE TWENTIETH CENTURY 



125 



when possible, be located near a group of 
wards, so that it may be easy of access. 
Very often the patients' sitting room or 
a sun-parlor may become the occupation 
room. 

With men patients, a part or all of the 
occupation room should be a shop, one 
which looks like a shop, with a floor that 
will not be injured by shavings and other 
debris. If basketry is done, by either men 
or women, a small tub of water will be 
needed ; the table and floor should there- 
fore be of material not harmed by 
wetting. 

If the occupation room or shop is at 
a distance from the wards, it should have 
near it a rest room furnished with a couch 
and easy chairs. Overdoing is always to 
be guarded against, and the teacher of oc- 
cupation will need to have facilities for 
her patients to rest at proper intervals. 

The occupation room or shop must 
have good light, preferably sunshine, and 
ample artificial lighting for dark days. 
Plenty of storage space for bulky ma- 
terials is necessary in closets or cupboards 
with shelves, hooks, drawers or boxes for 
small articles. There should be a place to 
lock up small tools. In even a small de- 





Courtesy "T 
FIG. 145 



Modern Hospit 
OCCUPATION ROOM, CHICAGO STATE 



Courtesy "The Modern Hospital" 

FIG. 146. OCCUPATIONS CARRIED ON IN THE 
WARD SOLARIUM, GENERAL HOSPITAL 
NO. 3, RAHWAY, N. J. 

partment one needs a table or bench for 
woodwork, a large table for basketry and 
a table for painting. There should be 
space to store partly finished work, and a 
cupboard with lock for finished articles. 
In most institutions a display case will be 
placed in or near the main office, so that 
visitors may see the patients' work, or 
purchase it. 

Miss Susan E. Tracy, an authority on 
occupation, suggests that an occupation 
room may be a sitting room, 
veranda, roof garden, sun 
parlor, or any large room. 
She specifies as hindrances 
to satisfactory work base- 
ment rooms with poor light, 
noisy rooms, parlors or 
rooms with furnishings 
that are easily damaged, 
very small rooms or those 
reached by long corridors. 

Most institutions which 
established this work find it 
quickly outgows its original 
quarters. Space is there- 
fore the great need, and 
rooms large enough for 
several good - sized work 
hospital. tables. 



126 



THE AMERICAN HOSPITAL 



CHAPTER VI. 

&fje jHaternttp department 



There is a growing call for maternity 
service in nearly every hospital, whether 
it be large or small. This has made it 
necessary to establish an obstetrical de- 
partment, either by setting apart a sec- 
tion of some building, calling into requi- 
sition an existing dwelling near the in- 
stitution, or erecting a new building or 
group of buildings for this one service. 

Most obstetricians declare that the ma- 
ternity service should be classed as sur- 
gical, since the area of open wound is 
greater than in almost any other clean 
surgery, and hence is subject to greater 
danger of infection from outside. Cer- 
tainly modern asepsis plays its part in 
this department, and many a mother 
owes her health and perhaps her life to 
the modern methods of care. 

Moreover there are many emergencies 
arising which can neither be foreseen 
nor prevented, and which can be proper- 
ly dealt with only by extra help and 
under hospital conditions. 

In order to care for obstetric cases to 
the best advantage, the hospital or de 
partment must be specially planned for 
the work. Study is necessary toward 
minimizing the noises of preparing and 
serving food, provision should be made 
for privacy or semi-privacy in the ward, 
and preparation made for emergency 
conditions. 

There are four distinct departments 
to be considered in planning for obstet- 
rical cases : 

1. The waiting department. 

2. The delivery or confinement rooms. 

3. The puerperal or after-confinement 
rooms. 

4. The creche or nursery. 

Waiting Department. With private 
patients, as a general thing, the patient 
goes to the hospital but a dav or two be- 
fore, or even on the day of delivery, and 
occupies at once the room or bed that 
will be hers during her recoverv. In 
hospitals where charity patients predom- 



inate the patients frequently enter from 
one to three months before confinement. 
Such women assist about the hospital 
work and in a measure repay for their 
care when sick. Where such a practice 
prevails separate wards or dormitories 
must be provided. In charity homes for 
unmarried mothers the situation is the 
same, and in many the waiting depart- 
ents are larger than the hospital proper. 

The location of this department in the 
hospital group should have most careful 
study for two reasons : 

1st — Because, owing to the cry- 
ing of the infants, it can well be 
called the most noisy of all the de- 
partments ; and 

2d — Because, owing to the pos- 
sible danger of infection from out- 
side sources, it should be as far re- 
moved as possible from the other 
buildings, and should not be used as 
a passageway to any other buildings. 
Delivery Rooms. The delivery rooms, 
with their sterilizing rooms, labor rooms,, 
doctors' waiting room, etc., should be 
cut off from the rest of the department 
by doors. This department should be 
treated in its details like an operating 
suite. 

The delivery rooms should be large, 
well lighted, and well ventilated ; should, 
in fact, be operating rooms with all the 
careful finish and detail, and should be 
equipped both for day and for night 
work. 

Either a special sterilizing room 
should be provided, or sterilizers for 
water, utensils and instruments must be 
placed in the delivery room. 

There should at least be one scrub-up 
sink in or near each delivery room. In 
hospitals where mixed cases, colored and 
white, free and pay, are taken, it is con- 
sidered wise to provide separate delivery 
rooms for the different classes. 

Patients' Rooms. If open wards are 
used, it is well to have them small : or, if 



OF THE TWENTIETH CENTURY 



127 



the ward is large, subdivided by fixed 
screens. A certain number of private 
rooms should be provided, and perhaps 
a few suites with baths. The finish and 
detail, toilets, sinks, baths, etc., should 
be similar to those of the surgical wards 
of the hospital. 

Airing balconies should be provided 
as in the medical and surgical wards, or 



rooms should be treated and equipped 
the same as isolation wards for conta- 
gious cases. 

Creche or Nursery. The nursery 
should be light, well-ventilated, cheerful 
and warm, and well away from the 
mothers. There should be not only space 
for a separate bassinet for each baby, 
but a separate room for bathing and 





Hojpitau Pavilion 

Talitha cumi Maternity Home. 
Jamaica Plain Ma^3. 

tDWAUD F. -5teVENJ,Ar<:hiTECT BOSTON MASS. 

FIG. 147. 



A Airing Balcony 

£ NUR-St'5 Rooms 

C. NuRSElS" -Sitting Room 

j> Private. Wards 

E. iTont Closet 

F Broom Closet 

6 Toilet 

H Blankets and Linen 
I Laboratory 
J Nurses Room Isolation Suite 

H TOILET 

L Patient " " 

M Diet Kitchen 
N Elevator. 

O COVERED PORCH 

P Corridor, and .solarium 





Second Floor. Plan 

5CA..E 

Hospital Pavilion 
TaliTha Cumi Maternity Home. 

Jamaica Tlain Mass. 
Edward f Stevens Architect Boston Mas5. 

FIG. 148. 



Kel-y 
A Air-ino Balcony 
£> Wards 
C 6tore Closet 
D Clothino Room 
C Linen •■ 

F To ILET 

Cr B.LANKET WARM 

H B~room Closet 
1 Delivery Room, 
J Sterilizing •• 
K OlET Kitchen 
L. Eleyato-r. 
M Poctors Room 



solaria can be added if found desirable. 

There should be opportunity for the 
isolating of the occasional cases which 
may be infected. A simple suite of two 
rooms and a bath, which will serve as a 
general utility room, should be arranged 
on a separate corridor entered from the 
main corridor, and with an outside en- 
trance as well, if possible. This arrange- 
ment will give opportunity for such iso- 
lation, but will not prevent the use of 
these rooms for regular work. The 



dressing. A balcony should connect with 
this room, so that the babies may be eas- 
ily kept out of doors in suitable weather. 
Linen closet, blanket warmer, linen 
dryer, etc., should be planned. If the 
department is large a creche may be pro- 
vided for ward babies and another for 
those belonging to private patients. 

A few concrete examples will serve to 
illustrate. In the Newton Hospital, 
Newton, Mass., the maternity service is 
cared for in a building recently erected 



128 



THE AMERICAN HOSPITAL 



in memory of the founders of the insti- 
tution. This huilding is connected with 
the main group by an underground pas- 
sage, and on the first floor by an open 
corridor. 

The public ward is on the first floor, 
together with four private rooms. There 
are baby rooms, diet kitchen, toilets, lin- 
en and medicine closets. 



The second floor is devoted to pri- 
vate rooms. The creche is on the south, 
with its own airing balcony. 

On the third floor are the delivery 
rooms for ward and for private patients, 
with sterilizing room between. A nurses' 
duty room, guests' rooms, isolating room 
toilets and storeroom complete this floor. 

The Talitha Cumi Maternity (Fig. 




•MA£TE|I2NITY~- PAV1LI02ST ■ 
•MfrADVILLE- CITY M05PITAL- 

■ MCADVILLE' PENN 
•EDWARD ■ F • STEVENS -ARCHITECT 
•BOSTON MASS' 

FIG. 149. 



130 



THE AMERICAN HOSPITAL 



FIG. 151. 



MATERNITY OPERATING ROOM— BRIDGEPORT HOSPITAL, BRIDGEPORT, 
Edward F. Stevens, Architect. 



CONN. 



451), Jamaica Plain, Mass., is an insti- 
tution for young, unmarried mothers. The 
waiting department is larger than the 
hospital proper, and is arranged as an 
industrial home. In this building are the 
offices of the institution, the kitchen, and 
dining-rooms. The hospital proper is 
connected with the waiting department 
by a closed corridor. 

On the first floor of the hospital build- 
ing (Fig. 147) is a six-bed ward, three 
private rooms, and an isolating suite so 
arranged that the doors leading into the 
corridor can be closed and the suite 
reached from the service staircase and 
from out-of-doors. There are toilets, 
bath, linen room, diet kitchen, and creche 
on this floor. An airing balcony and a 
solarium afford outdoor facilities. 

The second floor (Fig. 148) is similar, 
except that the delivery rooms replace 
the isolating suite. There are two deliv- 
ery rooms connected by the sterilizing 
room, and a doctors' room across the hall. 
The delivery rooms are cut off from the 
patients' part of the hospital by double 
doors. 



Mcadvillc Hospital, Meadville, Penn., 
bas a separate pavilion for the maternity 
service (Fig. 149). This pavilion is at 
the extreme end of a group of buildings. 
It is two stories in height, with elevator. 

There is but one public ward, the re- 
mainder of the patients being in private 
rooms. On the first floor is an isolation 
suite and a nurses' office. The delivery 
room, sterilizing room, doctors' room, 
etc., are on the second floor. Each floor 
has a creche, which contains an unusual 
feature, a fireplace. There are the usual 
airing balconies and a solarium. 

In the maternity department of the 
Bridgeport Hospital (Figs. 69 and 70) 
the ward unit is somewhat different from 
that of any of the other hospitals men- 
tioned in this chapter. In the main six- 
teen-bed ward the principle adopted lfi 
the Rigs Hospital is introduced — that is, 
there are four groups of four beds each, 
and these groups are divided by station- 
ary screens, six feet in height, giving the 
semi-isolation needed in these rooms. 

The creche (Fig. 150), as well as the 
serving-kitchen and sink-room, is at a 



OF THE TWENTIETH CENTURY 



131 




FIG. 152. ST. LUKE'S HOSPITAL, NEW BEDFORD, MASS. MATERNITY DEPARTMENT. 

Edward F. Stevens, Architect. 




FIG. 153. ST. LUKE'S HOSPITAL, NEW BEDFORD, MASS. MATERNITY DEPARTMENT. 

Edward F. Stevens, Architect. 



THE AMERICAN HOSPITAL 




C o c a i d o c 





1 1 






rnnrrn' 1 












i*rcttjt. P 



DCMWTICfWIl/DmG 




MATUfflnYEsmjocr 

FIG. 156. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS. 
FIRST FLOOR PLAN. 
Kendall, Taylor & Stevens, Architects. 




MaiEHTtY EMUCH 

FIG. 157. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS. 
SECOND FLOOR PLAN. 
Kendall, Taylor & Stevens, Architects. 



OF THE TWENTIETH CENTURY 




HAUEHrnrEwiuoM 

FIG. 158. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS. 
THIRD FLOOR PLAN. 
Kendall, Taylor & Stevens, Architects. 




NdWWflDMb 




KATL2HlTrawiU0N 

FIG. 159. WESSON MATERNITY HOSPITAL, SPRINGFIELD, MASS. 
FOURTH FLOOR PLAN. 
Kendall, Taylor & Stevens, Architects. 



136 



THE AMERICAN HOSPITAL 




Courtesy "The Modern Hospital" 



FIG. 160. JENNIE B. ROBINSON MEMORIAL, MASSACHUSETTS HOMEOPATHIC HOSPITAL, 

BOSTON, MASS. FIRST FLOOR. 
Kendall, Taylor & Company, Architects. 




Courtesy "The Modern Hospital" 



FIG. 162. JENNIE B. ROBINSON MEMORIAL, MASSACHUSETTS HOMEOPATHIC HOSPITAL, 

BOSTON, MASS. SECOND FLOOR. 
Kendall, Taylor & Company, Architects. 



OF THE TWENTIETH CENTURY 




Courtesy "The Modern Hospital" 



FIG. 163. JENNIE B. ROBINSON MEMORIAL, MASSACHUSETTS HOMEOPATHIC HOSPITAL, 

BOSTON, MASS. THIRD FLOOR. 
Kendall, Taylor & Company, Architects. 




Courtesy "The Modern Hospital" 



FIG. 164. JENNIE B. ROBINSON MEMORIAL, MASSACHUSETTS HOMEOPATHIC HOSPITAL, 

BOSTON, MASS. FOURTH FLOOR. 
Kendall, Taylor & Company, Architects. 



OF THE TWENTIETH CENTURY 



139 




140 



THE AMERICAN HOSPITAL 




FIG. 167. DELIVERY ROOM FLOOR, MATEI 

BOSTO 
Haven & H< 

distance from the ward and private- 
room patients. 

In this plan an admitting unit is pro- 
vided, in which the careful examination 
and bathing of patients are conducted. 
Adjoining this admitting unit is the iso- 
lation unit, in which any suspicious case 
can be kept for observation. This isola- 
tion department is connected with the 
serving kitchen of the children's depart- 
ment by a slide. Directly under the slide 
is the dish sterilizer, the cover of which 
is controlled from both sides of the par- 
tition, so that the infected china can be 
returned through the dish sterilizer. 

The children's ward unit in this build- 
ing is similar to the maternity ward unit, 
except that the screens are of clear glass, 
permitting the nurse on duty to have 
close observation of all the children and 
still affording the necessary isolation. 

The maternity department of the Ohio 
Valley General Hospital (Fig. 101 ) is 
situated at the end of one of the wings, 
and consists of wards and private rooms, 
two delivery rooms, a creche, and waiting 
room. Cases needing isolation are taken 
to the isolating department in the same 
building. 

At the St. Luke's Hospital (Figs. 152 
and 153), New Bedford, this service is 
taken care of in a separate building, with 



S T ITY DEPARTMENT, FAULKNER HOSPITAL, 
', MASS. 
t, Architects. 

a nearly ideal arrangement of rooms and 
service. 

Placed at the extreme end of the group 
and adjoining the ambulance entrance of 
the operating department, the admitting 
service is simple. The staff sitting room 
at this point makes a special waiting- 
room unnecessary. There is, however, a 
husband's waiting room provided for the 
anxious fathers-to-be. 

The admitting room, with entrance 
bath, adjoins the delivery corridor. 
There are three delivery rooms for the 
three services — public, semi-private and 
private. 

The public wards, two of eight beds 
each, accommodate the only patients oi\ 
the first floor, except the occasional iso- 
lated case, access for which is from a 
separate corridor. These ward beds are 
separated into groups of four by screens, 
upon which are located the nurses' calls 
and bedside lights. 

The Chicago Lying-in Hospital ( Figs. 
154 and 155), designed in conference 
with Dr. Joseph De Lee, the well-known 
obstetrician, is planned on the broad, 
generous basis of the comfort of the pa- 
tient, the isolation of sound, and the 
convenience of management. The nurses' 
station, located as it is at the crossing of 
the corridor at the elevator entrance. 



OF THE TWENTIETH CENTURY 



141 




142 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 




THE AMERICAN HOSPITAL 




FIG. 171. SHOWING NEW MATERNITY PAVILION. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



145 



makes possible the easy surveillance of 
the entire floor. The nursery and service 
rooms are placed with regard to care and 
easy service. 

On the sixth floor (Fig. 155) are lo- 
cated the operating section, the birth and 
labor rooms, so placed as to allow the 
utmost flexibility of service and at the 
same time the utmost privacy when pri- 
vacy is required. 

The sterilizing and nurses' room is 
centrally located. There is a waiting 




FIG. 172. GROUND FLOOR PLAN (CHILDREN'S 
DEPARTMENT), HENRY HEYWOOD 
MEMORIAL HOSPITAL, GARDNER, MASS. 
Edward F. Stevens, Architect. 



room for the husband and expectant 
father. 

The Wesson Maternity Hospital, 
Springfield, Mass. (Figs". 156-159), 
consists of three fireproof buildings and 
is a complete hospital unit. The plans 
of the patients' pavilion, nurses' home, 
and power plant, show the general rela- 
tion of one department to the others. 

The Jennie M. Robinson Memorial of 
the Massachusetts Homeopathic Hospi- 
tal, Boston (Figs. 160-164) presents the 
unique combination of an out-patient and 
a maternity department. The out patient 
department occupies the ground and first 
floors, the entrance for the maternity be- 
ing on another street. The prenatal 
clinic is on the second floor. 

The third floor is for public ward 
patients, the fourth for semi-private, the 
fifth for private patients. The largest 
wards have ten beds. Delivery and la- 
bor rooms are provided on the three 
floors, these being in a wing isolated 
from the rest of the floor. The nurseries 
are conveniently placed, yet well shut off. 
On each floor there is an isolating de- 
partment for special cases or for twi- 
light sleep. The duplication of service 
would not be necessary in most hospi- 
tals. 

The maternity department of the Ot- 
awa Civic Hospital, Ottawa, Canada 
(Fig. 81), has sixteen small wards, 
twenty-six private rooms, two delivery 
rooms (for private and for ward pa- 
tients), a labor room and three nurseries. 
Ample utilities facilitate service. A 
good isolation department is provided. 
The delivery rooms occupy what is in 
effect -a wing by itself. 

The maternity department of the 
Faulkner Hospital, Jamaica Plain, Mass., 
(Figs. 165, 166 and 167) presents an 
interesting method of saving floor space 
and therefore cost. The width of the 
corridors is reduced, and by using a 
splayed door jamb additional room is se- 
cured for the turning of stretchers or 
beds in the hall. This splayed space is 
utilized in the rooms for closets. 

The delivery rooms are on the third 
floor, and their floors are sound-proofed. 
Special features are : the bay window in 
the nursery, which gives additional sun- 



146 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



147 



light ; the blanket warmer and drying 
closet; the oriel from the nurses' utility 
room, which gives opportunity for the 
care of flowers at night in a temperature 
lower than that of the room ; the special 
rooms at the end of the building, which 
can easily be isolated if desired. 

The maternity building of the Beth- 
esda Hospital, Cincinnati, O. (Figs. 
168, 169 and 170), has in its basement 
comfortable rooms for internes, and a 
good hydro-therapeutic department. On 
the first floor are the offices and recep- 
tion room, with wards and private rooms 
for patients. The utilities are situated 
in the angle of the building. On the 
second floor are both wards and rooms 



for patients; the delivery artd operating 
rooms are shut off from the rest of the 
floor; there is a sterilizing room and a 
doctors' room in connection with them. 

For smaller units in private hospitals 
see plans of Macon Hospital (Fig. 107), 
Melrose Hospital (Fig. 303), the Good 
Samaritan Hospital, Sandusky, Ohio 
(Fig. 322), and the addition to the Hey- 
zvood Hospital, Gardner, Mass. (Figs. 
171 and 172). 

Several authorities urge, the provision 
of a small room which can be super- 
heated, for premature babies. Fig. 172A 
shows such a room. Bcllevue Hospital, 
New York, N. Y., has a similar room, 
large enough for ten cribs. 



« 



THE AMERICAN HOSPITAL 




"A LITTLE CHILD SHALL LEAD THEM.' 



OF THE TWENTIETH CENTURY 



149 



CHAPTER VII. 



JC&e Cfjtibren 

In planning for a children's hospital 
or a children's department of a general 
hospital we have new conditions that 
do not exist in any of the other depart- 
ments. We are dealing with suspicious 
cases, where the only logical treatment 
is to consider every case as having been 
exposed to some communicable disease 
and to provide proper isolation for the 
study of every new patient. To that end 
the admitting department should have a 
sufficient number of subdivisions so that 
each case may be temporarily isolated 
until a careful diagnosis can be made. 
During the usual period of incubation 
the children should be placed in an ob- 
servation ward, with the beds so sep- 
arated by screens, or otherwise, as to 
prevent the contact of one patient with 
another. These screens may be made of 
glass, or glazed cubicles can be provided 
that will give segregation and the neces- 
sary isolation. 

Where a children's department is 
placed in a general hospital, be the de- 
partment ever so small, it should be sep- 
arated from that portion of the hospital 
occupied by adults, which should be as- 
sured freedom from the noises coming 
from the children's ward and safety 
from the danger of infection. 

The necessity of providing private 
rooms is not so great in the children's 
hospital as in the adults', for it is found 
that chilchen are much happier if they 
can be with others, as their attention is 
taken from themselves, and they are 
likely to forget their own discomfort. 
Even in the general wards, however, out- 
side of the observation ward, a certain 
segregation or grouping is desirable. A 
glass screen partition between every three 
or four beds gives a sufficient amount of 
separation, but it is not desirable to have 
wards larger than from sixteen to twenty 
beds. 

As with the adult, every ward unit 



'* department 

should be supplied with one or two quiet 
rooms for the very sick. These rooms 
can be glazed so that the nurse from the 
corridor may watch the patient without 
the necessity of entering the room. 

One of the essentials in a children's 
ward unit is the day room or play room, 
for in this the little convalescents are 
freer to romp as much as their infirmi- 
ties will allow and to gather what com- 
fort they can from the toys furnished 
them. The floor covering of this room 
should be some warm material — linoleum 
or cork carpet, for instance, or even cork 
tile. 

The serving kitchen and sink room 
should be very little different from those 
provided for the adult ward units. The 
toilet and bath facilities, however, should 
be entirely different. The waterclosets 
should be low and easily accessible, as 
also should the wash basins. For bath- 
ing, the shallow tub or slab tub affords 
the most convenient method of washing 
children. Without undue effort on the 
part of the attending nurse the children 
can be washed in clean running water 
through a spray attached to a rubber 
hose. The temperature of the water can 
be controlled either by a control device 
or by a large storage tank placed direct- 
ly above the bathing slab. By using this 
method the patient is never washed in 
dirty or poisoned water, as is the case in 
bathing in a filled tub. (See Chapter 
XVI, "Plumbing.") In this bathing 
room should be placed a cabinet for the 
toilet articles of each individual child. 
This should be divided into compart- 
ments and should contain the usual mug, 
tooth brush, comb, and hair brush. 

A simple device to hold the toilet arti- 
cles of the children, devised by Mr. Bar- 
tine, superintendent of the Ruptured 
and Crippled Children's Hospital in New 
York, may be hung on the ena of each 
bed. This contains not only the toilet 



150 



THE AMERICAN HOSPITAL 



articles, but the towel also. Of course, 
this necessitates the taking of these arti- 
cles to the toilet room when they are to 
be used. 

The prevalence of contagions diseases 
in a children's hospital is so much greater 
than in the hospital of the adult that it 
is desirable to have a section of the hos- 
pital planned and set apart for the care 
of such diseases. This department 
should be treated the same as the con- 
tagious hospital — that is, there should be 



ment : ( 1 ) Balconies or roof space for 
two-thirds of the patients. (2) Isola- 
tion rooms for communicable diseases, 
respiratory cases and meningitis cases. 
(3) For babies, he urges a warm room 
with cubicles and humidity control. 

He advocates the cubicle system for 
all wards, not only as a means of limit- 
ing infections, but on account of drafts, 
which he considers a menace to babies. 

The question of color and decoration 
is one which requires careful study. The 




FIG. 173. CHILDREN'S WARD, ST. THOMAS' HOSPITAL, LONDON, 
ENGLAND. 



a certain number of cubicles or rooms 
where each individual bed is screened, 
and the same care maintained in the treat- 
ment of cases as in the contagious hos- 
pital. 

Here the orthopedic service is, as a 
general thing, greater than in the hos- 
pital for adults, and it is decided econo- 
my, if the hospital is large, to have a de- 
partment for the manufacture of cor- 
rective apparatus ; this is well illustrated 
in the Hospital for Sick Children in 
Toronto and in the Ruptured and Crip- 
pled Children's Hospital in New York. 

The requirements for operating rooms 
and surgical dressing rooms do not differ 
from those described in the chapter on 
the ward unit. 

. Dr. McLean, of the Babies' Hospital, 
New York, regards the following as es- 
sential in a children's hospital or depart- 



children can sometimes be quieted more 
easily by pictures on the walls than in 
any other way. Simple illustrations 
from Mother Goose, stenciled at a con- 
venient height for the children to look 
at, is one way of providing for this. One 
of the most attractive wards which the 
writer has ever seen was in the children's 
department of the St. Thomas Hospital 
in London (Fig. 173). Here the walls 
were lined the entire height with tiles 
depicting interesting incidents in child 
life. The admitting room of the Forsyth 
Dental Clinic (Figs. 174 and 175) in 
Boston is another good example of cer- 
amic decoration. 

A Few examples >r children's hospitals 
and departments will serve to illustrate 
some of the points which are mentioned. 

In the children's clinic of the Dussel- 
dorf Hospital, at the entrance is a small 



OF THE TWENTIETH CENTURY 



151 




FIG. 174. FORSYTH DENTAL INFIRMARY, BOSTON, MASS. CERAMIC FRIEZE IN 

WAITING ROOM. 



hospital isolation department of four 
beds, for the observation of doubtful 
cases. The ground floor is for the ac- 
commodation of infants and has an in- 
teresting incubator department consisting 
of six cells or tiny rooms, each for two 



cots. The lower portion of these is con- 
structed of marble and the upper of two 
layers of glass, with elaborate apparatus 
for controlling the temperature, humid- 
ity and veir ilation of each cell from the 
corridor. The utensils are contained in 




FIG. 175. FORSYTH DENTAL INFIRMARY, BOSTON, MASS. CERAMIC FRIEZE IN 

WAITING ROOM. 



152 



THE AMERICAN HOSPITAL 




FIG. 176. HARRIET LANE HOME FOR INVALID CHILDREN, JOHNS HOPKINS HOSPITAL, 

BALTIMORE, MD. 
Wyatt & Nolting, Butler & Rodman, Associated Architects. 



OF THE TWENTIETH CENTURY 



153 




FIG. 178. HOSPITAL FOR SICK CHILDREN, TORONTO, CANADA, ISOLATION PAVILION. 

Stevens & Lee, Architects. 



154 



THE AMERICAN HOSPITAL 



glazed compartments at the head of each 
bed. The first floor of the clinic con- 
tains the wards for the older children. 

The Harriet Lane Home for Invalid 
Children (Fig. 176 and Fig. 177) (the 
children's department of the Johns 
Hopkins Hospital), planned by Mr. 
Charles Butler, of New York (in col- 
laboration with Wyatt & Nolting of Bal- 
timore), to whom the writer is indebted 
for the data, is worked out most care- 
fully to provide for the proper observa- 
tion and segregation. This plan consists 
of the main building, with three small 
ward units. The patient enters through 
the main admitting room, with the ex- 
amining rooms adjoining. Suspicious 
cases are admitted through what is 
termed the infectious waiting-room, and 
one of the three wards provided is for 
observation purposes. In this, each bed 
is screened from its neighbor by a close 
glass and metal screen. Each of these 
ward units contains a duty room, sink 
room, bath room, isolation room, and a 
serving kitchen with nurses' dining- 
room adjoining. 

Perhaps no children's hospital in this 
part of the world is doing greater work 
than The Hospital for Sick Children, at 
Toronto, which administers more to poor 
children than to the children of the rich, 
both in the outdoor and in the indoor de- 
partments, as well as in the summer 
Lakeside Home. 

The isolation building (Figs. 178 and 
179) of this group is planned particular- 
ly for the care of an epidemic and for 
small children. It is designed on the 
principle of the Pasteur Hospital in 
Paris, and will be described in detail in 
the chapter on contagious hospitals. It 
provides for absolute isolation of sus- 
pected cases, or contagious cases as they 
develop. A separate entrance, separate 
elevator, and a separate corps of nurses 
are provided for this section of the hos- 
pital. 

This hospital carries on a very largo 
out-patient clinic. (See plan Out Patient 
Department, Fig. 278). The original 
hospital has been remodeled, airing bal- 
conies and clay rooms added, and the 
wards opened up and brought into the 
sunlight. 





FIG. 181. MELROSE HOSPITAL, MELROSE, MASS. CHILDREN'S WARD. 



150 



THE AMERICAN HOSPITAL 



FIG. 132. CHILDREN'S WARD, MATERNITY BUILDING, BRIDGEPORT HOSPITAL, 

BRIDGEPORT, CONN. 
Edward F. Stevens, Architect. 



One department of this hospital which 
probably no other hospital of its size has 
is the complete plant for the pasteuriza- 
tion and modification of all milk, not only 
for the hospital, but for a very large out- 
patient distribution. This department 
has the most modern, up-to-date equip- 
ment. (Fig. 180.) 

Two or three examples of children s 
departments in general hospitals will 
illustrate some of the points suggested in 
the preceding paragraphs. 

In a small hospital in Melrose, Mass. 
(Fig. 304), the children's department, 
although very small, is separated from 
the main corridor by two glazed doors. 
The ward (Fig. 181) is connected with 
a large outside airing balcony, and is 
provided with special children's toilet, 
and a small isolation room with glazed 
walls for better observation is provided. 

In the children's department of the 
Bridgeport Hospital (Fig. 182), Bridge- 
port, Conn., eighteen children are cared 
for in the main ward. This ward is sub- 



divided by glazed screens into groups of 
four or five beds each, the glazed screens 
permitting perfect supervision. A small 
isolation room is provided for one or two 
more patients. A large, well-lighted clay 
room (Fig. 183), ample airing balcony, 
and complete service rooms, including 
serving kitchen, sink room, surgical 
dressing room, bathing room and toilets, 
are provided. 

The simple decoration on the walls of 
the main children's ward, depicting 
mountain scenery, and a large memorial 
window add to the color effect of this 
department. 

Adj oining the children's department is 
a small infectious department, consisting 
of two isolation rooms and an isolation 
toilet. This isolation department, while 
adjoining the children's department, can 
be entirely shut off and served from a 
cross corridor connecting with the ad- 
mitting department. (See Fig. 69.) 

Another good example of a children's 
ward building is shown in the plans of 



158 



THE AMERICAN HOSPITAL 




FIG. 185. WORCESTER CITY HOSPITAL, WORCESTER. MASS. CHILDREN'S BUILDING. 

Fuller & Delano, Architects. 



OF THE TWENTIETH CENTURY 



159 




the children's pavilion of the* Worcester 
City Hospital (Figs. 184 and 185). The 
wards, the private rooms, and the 
utilities are grouped around a central 
rotunda in such a way that surveillance is 
easily kept of every portion of the floor. 
Here the natural system of ventilation 
is used — i. e., ventilating the entire wards 
from the center of the ceiling, which 
slopes at an angle of at least thirty de- 



grees. This construction is well hidden 
in the exterior treatment. 

In the plans for the Hospital for Rup- 
tured and Crippled (Figs. 186-188), New 
York City, a most comprehensive scheme 
is carried out. This service is largely for 
children and the planning is simple and 
straightforward. The outpatient section, 
consisting of thoroughly equipped rooms 
and departments, is entered on the left 



160 



THE AMERICAN HOSPITAL 




FIG. 187. 



OF THE TWENTIETH CENTURY 



161 




FIG. 188. 



162 



THE AMERICAN HOSPITAL 





Courtesy, The Modem Hospital 

FIG. 189. CHILDREN'S HOSPITAL, DENVER, COLO. 
Maurice B. Briscoe, Architect. Dr. S. S. Goldwater, Consultant. 



of the center, while a corresponding 
entrance on the right enters the executive 
department. 

In the basement are the kitchen, the 
laundry, the heating plant, the brace 
shop, and storage for supplies. 

On the first floor are the out-patient 
department and the administration de- 
partment. 

The second floor contains the living 
quarters for the superintendent, staff, 
housekeeper and graduate nurses. 

On the third floor are the wards for 
girls and female adults, together with 
dining-rooms for patients. 

The fifth floor plan is similar, except 
that the operating department is here 
located. 

The fifth floor contains the class and 
school rooms and the large assembly halls 
for the children, while on the sixth are 
the great out-of-door wards and solari- 
ums. 

The color scheme throughout is most 
pleasing and is most artistically carried 
out. 

The Children's Hospital, Denver, Colo. 
(Figs. 189-193), which accommodates 
about seventy-five patients, has an un- 



usual plan, being a U-shaped building 
above the first floor. It has complete 
facilities for caring for private and ward 
patients and for outdoor treatment. 
There is an excellent operating depart- 
ment and a good X-ray. Ample isola- 
tion rooms, so necessary in children's 
work, are placed in a separate corridor 
on the lower floor. A kindergarten room 
and bedside teaching for the children 
who wish to keep up their school work 
are features of the hospital. 

The Heywood Hospital, Gardner, 
Mass., built a dozen years ago, has re- 
cently added a small children's depart- 
ment. (Fig. 172.) It contains private 
rooms, wards, surgical dressing room, 
play room, large airing balcony, and a 
special wash room with high slab tub, 
low toilet and low wash basin. In the 
admitting ward, three cases can be kept 
under observation. 

The Children's Hospital, Halifax. 
Nova Scotia, shows an addition to an 
existing building (Figs. 194 and 195) 
which doubles its capacity. In the base- 
ment, there is an isolation department for 
five or six patients, the main kitchen, 
dining room and a special milk room. 



OF THE TWENTIETH CENTURY 




THE AMERICAN HOSPITAL 




Courtesy, The Modern Hospital. 

FIG. 191. CHILDREN'S HOSPITAL, DENVER, COLO. 
Maurice B. Briscoe, Architect. Dr. S. S. Goldwater, Consultant. 



OF THE TWENTIETH CENTURY 



165 




168 



THE AMERICAN HOSPITAL 





FIG. 196. WILHELMINA HOSPITAL, VIENNA, AUSTRIA. CHILDREN'S WARD. 



The first floor is the main hospital ; it 
provides wards, single rooms, a special 
three-part observation ward, a surgical 
dressing room, a day room, and a large 
balcony. On the second floor are the 
nurses' quarters. 



The Wilhelmina Hospital, Vienna, 
Austria, has some good features. The 
illustration (Fig. 196) shows the divi- 
sion of a ward into cubicles. The pedes- 
tal at the left is the slab for bathing, the 
spray coming from above. 



170 



THE AMERICAN HOSPITAL 



CHAPTER VIII. 



Hfyt department for Communicable Btgeastes: 



In all the large general hospitals of 
Europe, departments for the care of 
communicable diseases are provided and 
generally consist of separate, detached 
buildings, which are complete units di- 
vided into small wards with complete 
service rooms and equipment. Among 
those which are particularly interesting 
technically are those at Eppendorf, Vir- 
chow, West End Berlin, and Linden- 
berg-Cologne. 

Perhaps no hospital in Europe has 



of the five years preceding my visit, with 
a service of nearly five thousand cases, 
showed the cross or internal infection 
to be only two to the thousand. 

Friends are allowed to visit the pa- 
tients, communicating with them from 
the open balcony provided for the pur- 
pose. This balcony extends in front of 
all rooms. 

In an interview with Dr. Louis Mar- 
tin, the director of the Pasteur, and from 
his book,* '"Hygiene Hospitaliere," the 




FIG. 198. PASTEUR HOSPITAL, PARIS, FRANCE. FLOOR PLAN. 



carried the newer principles of infection 
to a higher development than the Pasteur 
Hospital in Paris. In 1907, visiting this 
hospital for the first time, one saw, to his 
great surprise, cases of scarlet fever, 
measles, diphtheria, sleeping sickness and 
other communicable diseases side by side 
in one building, within plain view of the 
nurse and the visitor and separated from 
each other only by plate glass partitions. 
Our training had been that to care safely 
for contagious cases one must have at 
least a separate department, if not sepa- 
rate buildings. Still more surprising was it 
to find that while these various diseases 
were in the same building and being 
cared for by the same nurse, the record 



writer gathered the following facts : 

(a) The service is divided into two 
sections — that for the very ill patients 
and that for convalescents. Between 
these two sections are the service 
rooms (Fig. 198) and fresh air pas- 
sages, so that the patient must pass 
through an area of fresh air in being 
transferred from one department to 
another. 

(b) In caring for all cases, the nurse 
wears a special gown for each room 
or cubicle, never removing the gown 
from the room except for cleansing. 

(c) After handling the patient or 

""Hygiene Hospitaliere." T. B. P.ailliere et Fils; 
Paris, 1907. 





FIG. 199. WILLARD PARKER HOSPITAL, NEW YORK, N. Y. MEASLES PAVILION. 



anything which the patient has touched, 
the nurse washes her hands thor- 
oughly. 

(d) All utensils are disinfected bv 
boiling or otherwise. 
This is Dr. Martin's description of the 
rooms. 

"The partitions of the room are 
glazed to facilitate surveillance and 



to render isolation less irksome to the 
patient, for through the glass parti- 
tions the patient remains in contact 
with the world outside, which is a 
great comfort to him. 

"The patient in his room ought to 
be sheltered from all cross infection, 
whether it be from the hospital or 
from outside. Everything which en- 



-4fgj == nzli 





•SECOND n_ODtL J>LAN ■ 



FIG. 200. KINGSTON AVENUE HOSPITAL, BROOKLYN, N. Y. ISOLATION PAVILION. 



THE AMERICAN HOSPITAL 




FIG. 201. WHITE ISOLATION BUILDING, ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. 
Edward F. Stevens, Architect; Mellen C. Greeley, Associate. 



OF THE TWENTIETH CENTURY 



173 





FIG. 202. WHITE ISOLATION BUILDING, ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. 
Edward F. Stevens, Architect; Mellen C. Greeley, Associate. 



ters the room shall be sterile, or at 
least freed from all noxious germs. All 
that leaves his room mut, also be stei 
ilized." 

In other words, the laws of antisepsis 
and aseptic surgical technique must be 
observed. 

On these principles many of our new- 
er American hospitals for contagion = 
diseases are now being built. The theory 
is that none, or comparatively few, of 
the communicable diseases is transmitted 
other than by contact, and the best au- 
thorities agree that true air-borne infec- 
tion is very rare. 

We should then plan our hospital for 
communicable diseases : 

1st — So that the nurse or doctor, 
after contact with the patient, can have 
ample and immediate opportunity to 
scrub the hands. 

2d — So that sterilizers can be pro- 
vided for sterilizing e\ery article that 
goes to the patient or is taken from the 
patient. 



3d — So that provision can be made 
for the removal and destruction of 
waste, either by local incinerators or 
properly protected receptacles to con- 
vey to the general destroyer. 
Then there must be the careful ob- 
servance of strictly surgical technique — 
i. e., as in the surgical case the area 
around the open wound is clean, unless 
infected by contact with some unsterile 
instrument, or unclean hands, so the area 
around the infected patient is clean un- 
less polluted by touch or contact from 
the patient or some one or something 
which the patient has touched. 

Perhaps no man in this country has 
given more thought and study to this 
subject than has Dr. Chas. V. Chapin,* 
the Providence, R. L, Health Commis- 
sioner, ably assisted by Dr. D. L. Rich- 
ardson, superintendent of the Provi- 
dence City Hospital. f Here theory is 

•"Sources and Modes of Infection." 

fDr. Richardon's excellent series of articles on "The 
Care of Infectious Diseases in Hospitals" was pub- 
lished in 1919 in The Modern Hospital. 




FIG. 204. ISOLATION BUILDING, ST. LUKE'S HOSPITAL, JACKSONVILLE, FLA. 

THREE-BED WARD. 




FIG. 206. HOSPITAL FOR SICK CHILDREN, TORONTO, CANADA. ISOLATION BUILDING 



176 



THE AMERICAN HOSPITAL 




1 



S 

3 

I 



«i 

H 

tn 
o 
H 
u 

s 

< 
O 

w 

s 

o 
H 

m 
H 
H 
W 
w 

a S2 

<2 

w is 

< O 

« m 

o 



OF THE TWENTIETH CENTURY 



179 




FIG. 210. ISOLATION DEPARTMENT, VICTORIA GENERAL HOSPITAL, HALIFAX. N. S. 

Stevens & Lee, Architects. 



supplemented by actual practice, with 
wonderfully satisfactory results. 

In the receiving building of this hos- 
pital one will see in rooms adjoining one 
another, cases of scarlet fever, diphtheria, 
erysipelas, and measles, with the same 
physicians, and the same nurses admin- 
istering to all, the latter eating in the 
same dining-room, living in the saim 
nurses' home with nurses of other de- 
partments of the hospital. 

As the service becomes larger or the 
diagnosis of the cases surer, then the 
grouping of the various diseases in dif- 
ferent buildings becomes an economy, 
but the technique is never relaxed. 

The buildings are ordinary ward units 
adapted to the care of communicable dis- 
eases by the addition of lavatories in 
each room and by other special equip- 
ment. 

In special cases, visitors are admitted 
directly to patients' rooms, but are seat- 
ed at a distance from the patient, in- 
structed not to touch him, and are close- 
ly watched by a nurse during their stay. 

One of the best planned isolation pa- 
vilions in this country is that recently 
built by the Department of Health of 
the City of New York at the Willard 
Parker Hospital, and used for a measles 



building (Fig. 199). Here, on the 
ground floor, one finds the best form of 
cubicle system. In addition to the spe- 
cial sink, lights, etc., each cubicle has a 
small well-ventilated toilet room entered 
from the room, containing a watercloset, 
making it unnecessary for the patient to 
leave the isolating room until he is con- 
valescent or discharged. 

The admitting pavilion ( Fig. 200 ) of 
the Kingston Avenue Hospital of the De- 
partment of Health, City of New York, 
is well planned, providing for separate 
service and entrance from the ouside, if 
necessary, to every room on the ground 
floor. This, too, has separate toilets for 
each cubicle or room. 

The contagious department of the St. 
Luke's Hospital, Jacksonville, Florida, 
consists of separate pavilions for white 
and colored ^See general plan, Fig. 18). 

The plan is an adaptation of that oi 
the Pasteur Hospital of Paris (Fig. 198) 
and does away with all the cumbersome 
and elaborate arrangements of the old 
school (Fig. 201). All classes of con- 
tagious diseases, with the exception of 
smallpox, which is still cared for at a 
distance from other people, largely on 
account of popular prejudice, are treated 
in one building. There are single rooms 



180 



THE AMERICAN HOSPITAL 



for fresh cases and wards for convales- 
cents. The rooms are cubicles, with 
glass partitions for ease of observation, 
each cubicle being a separate entity, com- 
plete in itself. Correct technique, the 
so-called "aseptic nursing," prevents the 
spread of infection, but facilities must 
be provided for carrying it out. 

The central portion of the building is 
the administrative department, being 
occupied by the admitting and discharge 
rooms and the various utilities, with the 
office of the nurse in charge. An open 
air cut-off separates this from the part 
occupied by patients. 

Each room or ward is furnished with 
a scrub-up sink, with elbow faucets, so 
that after any service for the patient the 
physician and the nurse scrub and disin- 
fect their hands before leaving the room 
They also wear gowns while carine for 
the patient, leaving them on hooks inside 
the door before they depart. 

The equipment consists of utensil ster- 
ilizers, which can be opened by the foot ; 
elbow handles for the faucets over slop 
sinks ; dish sterilizers large enough to 
take a tray and its dishes ; garbage in- 
cinerators which may be opened by el- 
bow ; liquid soap dispensers with pedal 
action ; lever door handles which can be 
opened by elbow or upper arm ; and 
everywhere scrub-up sinks with elbow 
handles. By means of these carefully 
worked out details the nurse is enabled 
to care for a patient, dispose of all waste 
material, and accomplish the disinfec- 
tion of all utensils and appliances used 
in the process, without touching any- 
thing else. At the close of each proce- 
dure she sterilizes her hands and re- 
moves her infected gown, becoming 
clean again, to start upon the same round 
with another patient. 

When a patient is admitted, he is 
bathed on the shallow tub-slab with a 
spray, so he gets what is practically a 
shower bath or shampoo in running 
water. He is then placed in a single 
room. When convalescent, he is trans- 
ferred to the small ward, where there 
may be other patients recovering from 
the same disease. This ward is treated 
as a unit, but the aseptic technique is 
still carried out. 

A portable tub (Fig. 203), similar in 



principle to the one in the admitting 
room, but made of wood covered with 
copper for lightness, set on a wheeled 
stretcher frame of the same height as the 
beds, is also provided. This may be 
taken to any room, the patient trans- 
ferred to it, and bathed with a spray at- 
tached to the faucet at the scrub-up sink. 
A floor drain in each room receives the 
waste water from the tub. The tub is 
disinfected after each using. 

When the patient has recovered and 
is to be discharged, he is taken through 
the open air corridor to the discharge 
room, given a cleansing and disinfecting 
bath, and passed into the dressing room, 
where he receives his own uninfected 
clothing. From this room he departs 
without coming into contact with other 
persons or parts of the buildings. (See 
also Figs. 203 and 204.) 

Hospital finish of the simplest and 
strictest sort has been carried out in 
these pavilions and everything made so 
as to be easily cleaned. The furniture 
is extremely simple, the rooms having 
no more than a bed, a comfortable chair, 
and a table, besides the all-important 
sink or lavatory. These sinks were made 
special, being provided with an integral 
drain-board upon which to place hand 
brushes and other appliances. 

The convalescent wards have toilets 
directly off them, and each has its own 
screened-in porch. 

All floors are of cement, painted. 
Washable rugs are provided for the 
rooms of the convalescents. 

Visitors are not allowed in the build- 
ing, but there is a narrow balcony run- 
ning in front of every room, like the 
Pasteur, so that parents and friends may 
come to the patient's window, see and 
talk with him, and know how he is get- 
ting on. This one provision probablv 
does as much as any one thing to estab- 
lish confidence in a contagious hospital. 

Though there is considered to be no 
adequate reason why the nurses caring 
for contagious cases may not mingle 
with other nurses, it has been deemed 
wisest, at the present time, to house them 
in the isolation pavilion. The second 
floor, ^ therefore, provides single rooms 
for six nurses, with baths, etc., these 
rooms being fully as commodious as 



OF THE TWENTIETH CENTURY 



181 



those at the nurses' residence. This 
floor has a separate entrance, through 
one of the open air corridors. 

The pavilion provided for white per- 
sons has rooms for patients on two floors 
one accommodating twenty and one 
eleven patients. 

The pavilion provided for colored per- 
sons accommodates eleven patients. It 
is an exact counterpart of the adminis- 
tration portion and one wing of the 
white pavilion. 

If the theory of isolation and the tech- 
nique of care are correct, then infectious 
diseases can be safely cared for in the 
general hospital. This is now being car- 
ried out in the Ohio Valley General Hos- 
pital. While this department (Fig. 102) 
is in the main building, it is nevertheless 
isolated by a fresh air cut-off from the 
other rooms on this floor. Separate serv- 
ing kitchen and sink room are provided 
as well as every facility for cleansing the 
person of the patient, for the work of 
the nurse, and all utilities. The nurse, 
after thoroughly cleansing her hands and 
changing the department gown, mingles 
freely with the other nurses of the hos- 
pital. 

The isolation unit (Figs. 179, 206), 
of the Hospital for Sick Children, Tor- 
onto, Canada, has been developed on the 
Pasteur principle, or much like the Isola- 
tion Department of St. Luke's Hospital 
at Jacksonville, with air cut-offs between 
the acute, the service, and the convales- 
cent departments. Each cubicle is pro- 
vided with the sink described in the 
Jacksonville Isolation. Food is delivered 
in the open corridor through a window 
to the serving kitchen. Under this win- 
dow is the dish sterilizer, the cover of 
which is controlled from either side of 
the wall. 

Small operating rooms are provided in 
each story. A separate staircase is also 
provided for the discharged patients, 
leading from the discharge room or 
cross corridor. 

The contagious department of the 
Massachusetts Homeopathic Hospital at 
Brighton (Fig. 207) provides for all 
classes of communicable diseases. The 
plan consists of a three building unit, 
connected by open corridors. The gen- 



eral administration building is in the 
center, flanked bv the ward units. 

The Jackson County Isolation Hos- 
pital, Jackson, Mich., is planned for four 
floors like the one shown (Fig. 209). 
The unit can easily be adapted to a build- 
ing of any height. The center is the 
service portion, and is kept uninfected. 
It has an open-air corridor wiiicb divides 
it from the ends, which are the parts oc- 
cupied by patients. In each patients' sec- 
tion there are four single rooms and two 




L 



r 



5 



Courtesy, The Architectural Forum. 



FIG. 211. ISOLATION BUILDING, HURLEY 
HOSPITAL, FLINT, MICH. 

Davis, McGrath & Kiessling, Architects. 

wards with two-bed cubicles. Each ward 
has a special scrub-up sink with elbow- 
control faucets ; each has its own toilet, 
those in the private wards being shut 
off by a washable curtain instead of a 
partition. The balcony is divided into 
three sections, one for each ward and one 
opening from the corridor. Visitors' 
balconies run the full length, and are 
accessible only from outside the building. 

The sink rooms, which are included in 
the service portion of the unit, open oi. 
the fresh-air cut-off. The commodious 
discharge rooms are noticeable, being de- 
signed so that two or more patients mav 
be discharged almost at once, or that a 
patient may have a comfortable place to 
rest while awaiting the conveyance to 



182 



THE AMERICAN HOSPiTAL 




take him home. There is a good serving 
kitchen, a linen room, a room for pa- 
tients' clean clothing, and special toilets 
for doctors and nurses. 

In the central portion of the ground 
floor is the admitting department. In the 
right wing is the children's out-patient 
department ; in the left wing is the 
genito-urinarv clinic, with rooms for the 
isolation and care of venereal cases (Fig. 
208). 

The isolation department of the Vic- 
toria General Hospital, Halifax, N. S. 
(Fig. 210), provides for patients in sepa- 
rate small rooms or cuhicles, each being 
complete. It has a special serving kitchen 
and utility rooms. The double-action 
plumbing fixtures make proper technique 
easy. 

The Children's Hospital at Halifax, 
N. S. (Fig. 194), has in its isolation de- 
partment a special room for a nurse, if it 
is desired to isolate her along with the 
patients. The Ottawa Civic Hospital. 
Ottawa (Fig. 80). the Notre Dame Hos- 
pital, Montreal ( Fig. 87), and the Good 
Samaritan Hospital, Sandusky, O. (Fig. 
320), present example; of small isolation 



departments in general hospitals which 
can be administered without disturbing 
the rest of the institution. 

The plan of the isolation building of 
the Hurley Hospital, Flint, Mich. (Figs. 
211, 212), was developed in collaboration 
with Dr. S. S. Goldwater, of New York. 
It diows a unit designed for twelve pa- 
tients, in two-bed wards. Each ward 
is an independent unit, with toilet and 
scrup-up facilities, and an exit to the ter- 
race outside. A portable tub is provided 
for bathing. The second floor, which 
houses three nurses and a maid, has a 
separate entrance ; it provides a sitting 
room, dining room and kitchen. 

The plan of an isolation ward for 
army hospitals, shown in the appendix 
(Fig. 13), gives a simple plan for carry- 
ing out an effective technique with a con- 
siderable number of patients. Two-bed 
cubicles and single rooms are provided, 
visitors' galleries, and all utilities. 

In hospitals which desire to isolate 
venereal cases, a department arranged 
as for other communicable cases may be 
modeled after some of the plans already 
given. 



OF THE TWENTIETH CENTURY 



183 



CHAPTER IX. 

Cfje Psipctjopatfjtc department 



Since the beginning of this century, no 
greater development has been made in 
any branch of hospital housing and treat- 
ment than in the psychopathic and 
neurological departments. 

Only a few years ago the person who 
was adjudgd insane was committed to 
an asylum ; and if resistance were offered 
he was placed in irons and half starved. 
The mild cases were herded with the vio- 
lent — "herded" is the only name for 
it — and they were treated more as beasts 
of the held than as human beings whose 
course of thought was diverted through 
some slight lesion. The scientific studv 
of the disturbed patient has shown that 
in most cases the modern or humane 
treatment is productive of the greatest 
success ; and phychopathic hospitals, 
either as independent institutions or as 
departments of a general hospital, are be- 
ing considered everywhere. The psycho- 
pathic hospital then become a clearing- 
house for the study and segregation of 
cases. 

Whether or not a general hospital 
should have a psychopathic department 
must be settled by local conditions, the 
interest of the men on the staff, etc. 
Since insanity and nervous conditions 
are said to be on the increase, and more 
attention is being paid to the care and 
cure of "borderline" mental cases, it 
would seem necessary for large hospitals 
to make some definite provision for these 
cases. It is quite certain that mental 
cases cannot be properly cared for among 
other patients, nor by nurses and at- 
tendants unfamiliar with their special re- 
quirements. A separate building or de- 
partment appears to be the only solution 

In any event, some provision should 
be made in all general hospitals for the 
proper isolation and protection of de- 
lirious patients. One or two rooms can 
he arranged for, situated so as not to dis- 
turb other patients, with windows prop- 
erlv guarded. Such departments are 



shown on the ground floors of the Ross 
pavilion of the Royal Victoria Hospital, 
Montreal (Fig. 114), the Ohio J 'alley 
General Hospital, Wheeling, W. Va. 
(Fig. 99), and the Ottazva Civic Hos- 
pital, Ottawa (Fig. 79). 

In this department more than in any 
other in the hospital it is essential to con- 
sider the environment of the patient ; the 
interior must be restful; there must be 
nothing in color or design to excite the 
patient ; the surroundings must be home- 
like, with as little of the institutional ap- 
pearance as possible. Great care should 
be used, however, to avoid giving any 
opportunity for the patient to inflict per- 
sonal injury, by providing non-projecting 
hardware; turned-down door handles; 
flush transom bars; lighting fixtures out 
of reach, with no projections; small 
lights of plate glass in windows, which 
never open enough to admit the body of 
a person ; special plumbing fixtures, firm- 
ly secured; and cabinets for telephones 
and service built into and not projecting 
from the wall. 

In the Psychiatric Clinic at Munich. 
Germany (Figs, 213, 214). one hundred 
and fifty patients are cared for, divided 
into first, second, and third classes, ac- 
cording to the service and accommoda- 
tion. Every class is provided with spe- 
cial visiting-day rooms wherein patients 
may receive their friends. 

Those in the first class have private 
rooms. For this accommodation, with 
services of nurse and doctor, they pay 
eleven marks ($2.75) per day. Every 
attempt is made to make the apartment's 
homelike, and no visible form of restraint 
is noticed. 

The second class patients have less 
luxurious accommodations but have com- 
fortable living rooms and sleeping quar- 
ters, for which they pay six and one-half 
marks ($1.63) per day. 

The third class patients occupy wards 
at three marks ($.75) per day. The 



THE AMERICAN HOSPITAL 



OF THE TWENTIETH CENTURY 



186 



THE AMERICAN HOSPITAL 




FIG. 215. PSYCHIATRIC- NEUROLOGICAL CLINIC, UTRECHT, HOLLAND. GROUND FLOOR. 



wards are neat and well kept, and toilets 
are provided in every ward unit. 

The details of construction are most 
carefully worked out. The door frames 
are of iron, with no projection; all door 
handles are turned down, affording no 
way to cause injury; all cabinets are of 
steel, placed flush with the wall ; the tele- 
phones are enclosed in cabinets, and sig- 



nal is given by a red light, no bells being 
used. 

In the new Psychiatric Clinic of the 
State University of Utrecht, Holland 
(Figs. 215-219), Professor Heilbronner 
has worked out some excellent ideas. 
One hundred patients are accommo- 
dated and all are placed on the first floor, 
which is divided into six sections — three 



188 



THE AMERICAN HOSPITAL 



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FIG. 218. PSYCHIATRIC- NEUROLOGICAL 
CLINIC, UTRECHT, HOLLAND. CORNER 
OF WARD. 

for women and three for men — and clas- 
sified according to condition. 

The offices, laboratories, etc., are lo- 
cated on the second and third floors of 
the main building. 

While this is strictly a pavilion type of 
hospital, all sections are connected by a 
common corridor, adjoining which is the 
working or domestic side of the institu- 
tion, the kitchens, dining-room, together 




FIG. 219. PSYCHIATRIC- NEUROLOGICAL 
CLINIC, UTRECHT, HOLLAND. DAY ROOM. 



190 



THE AMERICAN HOSPITAL 



with lecture rooms, etc. Each one of the 
patients' sections is supplied with Jie 
necessary utensils and equipment ; cacn 
has an examining room, so arranged 
with curtains that it can he changed into 
a dark room ; also a linen room, store 
room, sink room, tea kitchen, hath rooms, 
day room, and airing halcony. 

The hath rooms are centrally located 
and can be reached readily from the 
wards or single rooms. For the con- 
venience of the wards, a corner water- 
closet is provided, so screened as not to 
be objectionable, at the same time keep- 
ing the patients under the surveillance of 
the attendant. 

There are no large wards in any sec- 
tion, six beds at most. 

In the neurological section, where less 
surveillance is needed, the rooms are sep- 
arated by single doors ; while in the 
psychiatric sections the wards are divided 
by large sliding doors, making it easier 
for the night watch. 

In the psychiatric sections, three baths 
to every thirteen beds are provided. The 
control for these baths is behind locked 
cabinet doors, and if the temperature of 



the water varies beyond certain limits an 
electric alarm summons an attendant. 

In each psychiatric section is provided 
an isolation room with rounded corners, 
fastened-down toilet, protected lights, and 
protected double doors with an observa- 
tion window. The windows are made of 
swinging sash, divided by heavy rein- 
forced sash and glazed with heavy plate 
glass. The floors are covered with lino- 
leum. 

The administration offices, the labora- 
tories, and the sleeping quarters for the 
attendants are on the second and third 
stories. 

A large photographic gallery is ar- 
ranged for cinematography, and has spe- 
cial lights arranged for night photog- 
raphy. 

These two examples will show some- 
thing of the development of the psycho- 
pathic hospital in Europe ; but there 
every large hospital has its own psycho- 
pathic department, large or small, the 
needs and development dictate. 

In this country the first psychiatric hos- 
pital, especially designed for the purpose, 
was that of the University of Michigan, 




FIG. 221. MASSACHUSETTS PSYCHOPATHIC HOSPITAL, BOSTON, MASS. GROUND FLOOR. 

Kendall, Taylor & Co., Architects. 



OF THE TWENTIETH CENTURY 191 




omctW' ENI. MAIN ENTRANCE OUTPATIENT^' INT". 



flR-vST FLOOR. P LA N 



FIG. 222. 




SECOND FLOOR. PLAN 



FIG. 223. 

MASSACHUSETTS PSYCHOPATHIC HOSPITAL, BOSTON, MASS. 
Kendall, Taylor & Co., Architects. 



192 



THE AMERICAN HOSPITAL 





FOUR.TH FLOOR, PLAN 

FIG. 225. 

MASSACHUSETTS PSYCHOPATHIC HOSPITAL, BOSTON, MASS. 
Kendall, Taylor & Co., Architects. 



OF THE TWENTIETH CENTURY 



193 




Ceurtesy, The Modern Hospital 

FIG 226 PSYCHOPATHIC BUILDING, COOK COUNTY HOSPITAL, CHICAGO, ILL. 

FIRST FLOOR PLAN. 
Richard E. Schmidt, Garden & Martin, Architects. 



at Ann Arbor, built in 1906. It has a ca- 
pacity of sixty-two beds. 

In 1911 the State of Massachusetts ap- 
propriated the sum of six hundred thou- 
sand dollars, to be expended in the build- 
ing of the Massachusetts Psychopathic 
Hospital, in the City of Boston. The site 
selected was in what has come to be 
known as the "hospital district" of Bos- 
ton, located in close proximity to the Har- 
vard Medical School, the Peter Bent 
Brigham Hospital, the Infants', the Chil- 
dren's, the Good Samaritan, the New 
England Deaconess, the Robert Brigham, 
the Channing, the Huntington and ether 
hospitals. 

The work was intrusted to Henry H. 
Kendall, architect, under the direction of 
Dr. Owen Copp, executive officer of the 
State Board of Insanity. 



The development of this institution in 
Massachusetts has given the State a mag- 
nificent psychopathic building which 
forms the clearing-house, as it were, for 
the larger insane institutions throughout 
the state. 

The building is E-shaped, a plan giv- 
ing the greatest number of rooms ex- 
posed to the best light and air. It is four 
stories in height and will accommodate 
one hundred and ten patients. The pa- 
tients are generally admitted at the am- 
bulance entrance on the first floor, leading 
from the side street. 

On the first floor (Fig. 222) there are 
two admitting units, one for each sex, 
divided by a general corridor. These 
units consist of two admitting wards of 
five beds each, general treatment rooms, 
baths, isolation rooms, etc. Connected 



194 



THE AMERICAN HOSPITAL 





Ceurtesy, The Modern Hospital 

FIG. 228. PSYCHOPATHIC BUILDING, COOK COUNTY HOSPITAL, CHICAGO, ILL. 
HYDROTHERAPEUTIC DEPARTMENT ON TOP FLOOR. 
Richard E. Schmidt, Garden & Martin, Architects. 



OF THE TWENTIETH CENTURY 



195 



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FIG. 229. FIRST FLOOR— HENRY PHIPPS PSYCHIATRIC CLINIC, JOHNS HOPKINS HOSPITAL, 

BALTIMORE, MD. 
Grosvenor Atterbury, Architect. 



196 



THE AMERICAN HOSPITAL 



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FIG. 230. THIRD FLOOR— HENRY PHIPPS PSYCHIATRIC CLINIC, JOHNS HOPKINS HOSPITAL, 

BALTIMORE, MD. 
Grosvenor Atterbury, Architect. 



OF THE TWENTIETH CENTURY 



197 



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FIG. 231. FIFTH FLOOR— HENRY PHIPPS PSYCHIATRIC CLINIC, JOHNS HOPKINS HOSPITAL, 

BALTIMORE, MD. 
Grosvenor Atterbury, Architect. 



198 



THE AMERICAN HOSPITAL 




FIG. 231A. HENRY PHIPPS PSYCHIATRIC CLINIC, JOHNS HOPKINS HOSPITAL, 

BALTIMORE, MD. 
Grosvenor Atterbury, Architect. 



with this section are the operating and 
emergency department and the offices for 
the admitting officers. The remainder of 
the first floor is occupied by offices and 
quarters of administration, matron, and 
staff, and the general receiving depart- 
ment, containing waiting-room, examin- 
ing room, rooms for social service work- 
ers, etc. 

What might he termed the patients' 
building is separated from the main 
building by a short connecting corridor 
containing the elevator and staircase. 
The wards for the men are placed on the 
second floor and those for the women on 
the third floor (Fig. 224). Each has a 
section for disturbed cases, divided into 
separate rooms for each patient. 

As in the foreign hospitals previously 
described, the continuous bath is used 
largely in the treatments. 

Each ward unit has its own serving 
kitchen, and bath and toilet unit. 

A large out-door day-room on the roof 
(Fig. 225) affords opportunity for exer- 



cise and recreation, and as this institu- 
tion overlooks the splendid park system 
of the city the patients have much outside 
of themselves to occupy their minds. 

The PJiipps Clinic, a well-studied 
psychopathic department of the Johns 
Hopkins Hospital, shows much care and 
thought, not only in the planning but in 
the aesthetic side of hospital architecture. 
The restricted area made it necessary for 
the architect to carry the building five 
stories above the basement in order to 
provide for the needs of the department. 
For description, the writer is indebted 
to Adolph Meyer, M.D.* (Figs. 
229-231 A). 

There is an out-patients' department, 
with waiting room, which also is used in 
part for occupation classes, social work- 
ers, and examining rooms. 

In the hospital division there is an ad- 
mission ward, with provision for excited 
cases, as well as a semi-quiet ward, a 

* "The Modern Hospital," Vol. I, No. 2. 



OF THE TWENTIETH CENTURY 



199 



quiet ward, and a private quiet ward. A 
number of well-arranged, exclusively pri- 
vate suites and rooms are provided. 

The administrative portion is princi- 
pally on the north, consisting of offices 
for administration, laboratory and staff 
quarters. 

The medical treatment department con- 
sists of hypdotherapy and mechano- 
therapy. 

The top floor is reserved for the large 
recreation hall and roof gardens, charm- 
ingly designed and colored. 

The ward unit consists of an eight-bed 

ward. 

The psychopathic building of the Cook 



County Hospital, Chicago, 111., (Figs. 
226-228) is well planned. The general 
scheme is not unlike that of the Boston 
Psychopathic. 

The psychiatric wards of the army hos- 
pitals used by the United States during 
the war (Fig. 12 Appendix) are de- 
signed to accommodate twenty-eight pa- 
tients, in single rooms and in wards of 
three or four beds. Day rooms commu- 
nicate almost directly with wards and 
rooms. Each day room has a balcony, 
not connected with any other. Perhaps 
the best feature of the plan is that one 
can pass from one section to another with- 
out going through other rooms. 



200 



THE AMERICAN HOSPITAL 



CHAPTER X. 

® f)e tKuberculosiis! department 



The care of patients afflicted with pul- 
monary tuberculosis demands special 
study for the problem is totally different, 
from almost every point of view, from 
that of the treatment of the general pa- 
tient, whether surgical, medical, or con- 
tagious, in the number of gradations of 
patients and the different care required 
for each grade. 

If we are to plan for the care of 
tuberculous patients on the grounds of 
the general hospital, then a portion of the 
site should be selected remote from the 
other patients' buildings, but with equal 
regard to sunlight and protection from 
the cold winds. If, as is more likely to 
be the case, the tuberculosis hospital or 
sanatorium is to be isolated and an in- 
stitution by itself, and a site is selected 
remote from water, sewerage, and other 
municipal service, then the problems are 
increased many fold, and the natural con- 
tour, the nature of the land, and the 
meteorological conditions must be care- 
fully studied. 

If planning for "all comers," it will be 
necessary to plan on about fifty per cent 
of the patients being of the ambulatory 
class, who are able to be up and about 
and to do light work. Plans must be 
made for ground room for exercise and 
recreation, buildings for light industrial 
work, buildings for dining and entertain- 
ment rooms, facilities in other wards for 
carrying on the various activities of life 
under hygienic and supervised conditions, 
the main aim being to have the maximum 
amount of sunshine, fresh air, and abso- 
lute ventilation. 

The area of land must not be restricted 
and it should have level stretches about 
the buildings. The outlook and general 
environment are almost as important as 
sunlight and ventilation — e. g., an other- 
wise beautiful site might lose much of 
the therapeutic value if a cemetery were 
in the immediate foreground, or if sit- 



uated near noisy manufacturing plants 
or smoking chimneys. 

The average incipient patient soon 
wearies of his enforced confinement ; and 
unless the natural attractions are consid- 
ered he becomes discontented and leaves, 
so that the sanatorium may be without 
patients. 

In providing service for tuberculosis 
cases they may be roughly divided into 
three general groups : 

1st — Those in the last stages, in many 
instances dying patients ; 

2nd — The acute but recoverable cases, 
who are in accordance with present meth- 
ods, kept in bed until their temperature 
subsides. 

3rd — The ambulatory cases, with in- 
cipient or even moderately advanced 
cases, incapable of regular work yet 
enjoying a reasonable degree of health; 

4th — The out-patient who, while need- 
ing treatment through the day, may re- 
turn to his home at night under proper 
supervision. 

For the treatment of the first class, 
wards or private rooms not unlike other 
medical wards or private rooms should 
be provided. 

Proper care must be exercised for the 




FIG. 232. REVOLVING AIRING BALCONY, 
AMSTERDAM HOSPITAL, AMSTERDAM 
HOLLAND. 



OF THE TWENTIETH CENTURY 



201 




r !JZ^5T r LOO 12- 



FIG. 233. PROPOSED TUBERCULOSIS UNIT, CITY OF JACKSONVILLE, FLA. 



protection of the nurse and the preven- 
tion of the spread of disease. 

For the comfort of the patients the 
wards should not be too large; if sub- 
divided by permanent screens they may 
become less depressing. Everything pos- 
sible should be done to brighten the ward, 
and there should be provided a wealth of 
sunshine and plenty of out-of-door bal- 
conies. 

As the death rate in these wards will 
naturally be greater than in any other 
part of the institution, the method of re- 
moving the body from the building so as 
to attract the least attention should be 
studied. If the morgue can be at_ some 
little distance from the wards, with an 
underground connection, much mental 
suffering will be avoided. 

The acute cases should be in outdoor 
wards or in rooms well open to the air, 
much as the ambulatory cases are. Nurs- 
ing facilities must be provided for them, 
however, practically the same as those for 
the third-stage cases, since in many insti- 



tutions these patients are not allowed to 
get out of bed. 

For the ambulatory case the problem 
is very different. Here there are patients 
who are up and dressed, and active to a 
certain degree, but for whom there must 
be provided proper sleeping quarters, 
with due regard to the out-of-door treat- 
ment recommended for this class. There 
must also be dressing and bath rooms 
which can be warmed in cold weather, 
recreation rooms for stormy weather, rec- 
reation parks for pleasant weather, and 
light employment for certain hours. 
Every ambulatory patient should have a 
cupboard, locker, or closet, which will be 
large enough to be entered and to contain 
his personal belongings. This cupboard 
should be well lighted, well ventilated, 
and well heated ; for to the lonely man 
away from family and friends this may 
be the only place which he may call his 
very own. Such a cupboard should not 
be less than three by four feet in size, 
and should contain a seat, shelves, mirror, 



202 



THE AMERICAN HOSPITAL 



2, o o p 



NUE./t/ 

E-OOM 



PRIVATE E.OOM 



J 



l T [51 (o) 

TO 1 LET ' 



£>atm 

"12 

Diet Kitchen^ 



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PRIVATE EOOM 



Pout £ed Waed 
foe. men 



Foue. .Bed Wae,d 
Foe, Women 



Aie-ing Balcony 



yeco/sD flool 



FIG. 234. PROPOSED TUBERCULOSIS UNIT, CITY OF JACKSONVILLE, FLA. 



and any other conveniences which expe- 
rience may dictate. 

The toilets should be of sufficient size 
to accommodate the patients of the par- 
ticular unit which they serve, and should 
be reasonably near the sleeping quarters. 

The general room or day room should 
be light and cheerful, as it is the living- 
room of the family or the unit which it 
serves. 

The sleeping quarters can be in wards, 
with beds on either side, with plenty of 
windows to open, or of the "tent" or 
"shack" form, open toward the south, 
with beds to the north. The modification 
of the shack has become perhaps the most 
popular form for the housing of incipi- 
ents, for with this type the bed of the 
patient can be brought practically into 
the open when desired. The south can be 
closed with swinging sash or cloth screens, 
or can be left entirely open. 

Scopes and Feustmann, architects, New 
York, call attention to the fact that cheap- 
ness of shack construction has often led 
committees to neglect to provide the nec- 



essary comforts. In nearly all places 
some provision must be made for cold 
weather, and for severe storms. In 
county tuberculosis sanitaria there is sure 
to be a considerable number of acute and 
advanced cases, who require nursing and 
some degree of comfort, and who can- 
not be properly cared for in shacks. (*) 
Nearly every tuberculosis hospital or 
sanatorium has its out-patient clinic, 
where the patient spends the day on the 
sunny lawn or broad terraces, receiving 
nourishing food and good advice for 
home living. For this work the principal 
equipment is steamer chairs, blankets, 
serving kitchens, and intelligent attend- 
ants. This educational and helpful 
work, followed up as it is by the social 
service work of the institutions, is accom- 
plishing important results in the stamp- 
ing out of the great white plague. The 
Boston Consumptives' Hospital, Matta- 
pan, Mass., is one of the institutions 
which does an extensive out-patient work. 

* "The County Tuberculosis Sanitarium," in the 
Architectural Forum, June, 1919. 



OF THE TWENTIETH CENTURY 



203 



JtA VIEW HQ/-PITAL tXT£N/ION 
/TATEN I/LAND - NEW YOUK. 
DtMJHMENT « PUBLIC CHAfclTIL/ 

tPWAlD f /TMHJ - So/TON.MAJ/1 Ay./0CIATt6 
ItNWICK.ArtWWALLt TvCKiV. - NEW YOlln J ARCHITECT/ 
- f OK NtW «W.t i f tMALt J> AVILIONy. 

Building c Dinino Hall- 




FIG. 235. PLOT PLAN. 



In the large city and county institu- 
tions the industrial work of the institu- 
tion can be done largely by the patients, 
with a tailor shop for the mending of 
patients' clothing, a harness shop for all 
leather work, carpenter shop for the 
necessary repairing, sewing rooms for re- 
pairing the linen and the making up of 
new material. Light employment during 
certain hours can be made a profit to the 
institution and a help to the patient. 
Waiting on tables and the light janitor 
work about the building can all be done 
by the patients. Dr. Marcus Paterson, 
of Frimley, England, has had remark- 
able results with carefully controlled oc- 
cupational therapy, using such work as 



flower and vegetable gardening, chicken 
raising, etc., and extending to the care o'fj 
lawn and grounds, painting, grading, 
etc. (*) 

For the ambulatory class, dining-rooms 
must be provided, general assembly rooms 
for religious and secular services, recrea- 
tion rooms, reading rooms, store and post- 
office, as well as general examining rooms, 
dental rooms, barber shops, etc. 

An operating department should be 
provided, for the presence of tubercular 
germs does not prevent appendicitis or 
other troubles. If care in an acute hos- 
pital is easily available, the operating 

* "Auto-inoculation in Pulmonary Tuberculosis," 
Marcus Paterson, M. D. 



204 THE AMERICAN HOSPITAL 



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o 


o 


1 o 


o 


o o o 


o o o 


o 


o 


o 


o 


o o 


o 


o o o 


o o o 


o 


o 


o 


o 


o o 


o 


o o o 


o o o 


o 


o 


o 


o 



HltHI C( ' COOK! 



C ; II 



MtN/ CoftT &0OMI 



/tEVING 

PANTIV 



Pining Hall Builping 
fie/T FlOoi!. -Plan 



ENLARGEMENT - JtA VltW llQ/HTAl 
./TATEN 1/LANP ~ NtW YO£K 

PtPACTMtNT •■ PUBLIC CHAMTJI/ 



Bo/ton, NW^~I A//ociatc* 



FIG. 236. 




ENLAtQCMtNT ~ yEAYltW ttO/WAL 
/TATEN l/LAND ~ NtW YofcK 
depahtm tNT Public Cmaiutie/ 

A//oo»tu> 



FIG. 237. 



OF THE TWENTIETH CENTURY 



Quoup Building 

flE/T fLOOH PLAM 




ENLARGEMENT ",/EAVlLW HO/WTAL 
/TATEN l/LAND ~ NEW YO£K 

DCPAE.TME.NT •» PUBLIC CttAUITIE/ 

tDWAUD f. /TtVCN/ — &CVTON, MAS'] A//OClATtD 
luwici., Hynt<w«LL t Tucntl-Ntw YotK J AicmTtCTy 



J IG. 238. 



GlOUP B>UILDJNG. 
/ICONO TLOOi Plan. 




O — I 



FIG. 239. 



ENLAEQtMtNT "7EAVIEW flO/WTAL 
./TATEN l/LAND - NtW YoilK 

D£J>A*TM.tNT « -PobUC CmaWTIE/ 

Itiwiw, A/riMMu . T-,«te~ Nt „ To.*/ Atc»,T»CTy 



206 



THE AMERICAN HOSPITAL 




Women/' -Paviliom 



DDDLDQDQDQ] 



Oj>tN Aia DofcAMTOtY 



LNlAHQEMlNT t ° y£A view Ho/pital 
/TATEN INLAND — NEW Youk. 
DtPflETMtNT •» Public CHARiTitJ- 



FIG. 240. 



□ in m □□ CD HI □ 



OfLN AlB DOEfAlTOtY 



MtW Pavilion 

fllUT-fLOOt-PLAN 



"I 




ENLARGEMENT ™ y EA VIEW tlO/PITAL 
/tat en L/land — New York. 

DtPAD.TMt.NT •» Public CMAciTit/ 

tDWABD f/TevtN/- — Boston, PAa/A A//ociatlo 



FIG. 241. 



OF THE TWENTIETH CENTURY 



207 




nnnonnnph 

in p p n n d n | r^f ,f jp o n a n o dCT : 



LEGEND 


A 


WAS.DJ - 


B 


CORRI DORS 


C 


store closet 


D 


LININ CLOitT 


L 


BOWL ROOM 


F 


5LR.V1NG RM 


C 


BATH ROOM 


H 


UTLNSIL RVi 


1 


TOILET ROOM 


J 


STAIR.CA5E 




LOCKJR. R>1 


L 


LABORATORY 


M 


PIAZZA 


H 


CORRIDOR- 


O 


TUNNEL. 


V 


VENT DUCTS 



FIG. 242. 



BOSTON CONSUMPTIVES' HOSPITAL, WARD BUILDING 
Maginnis & Walsh, Architects. 



\4 WaJoofJoAdJor 



p 



Q 



onnnmmuolj 

5 ^ 



ail 



Lt CEND 
A ASSEMBLY ROOM 
5 W A tLD 
C LOCKER, R.OOM 
D TOILET 
E NUfcSE'5 R.OOM 
F EMERGENCY ROOM 
G PIAZZA 




Tib d d Ofl atJ d tl rJQH 



FIG. 243. BOSTON CONSUMPTIVES' HOSPITAL, COTTAGE FLOOR PLAN. 
Maginnis & Walsh, Architects. 



208 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



209 




210 



THE AMERICAN HOSPITAL 





FIG. 247. PLOT PLAN— CENTRAL NEW ENGLAND SANATORIUM, RUTLAND, MASS. 
Edward F. Stevens, Architect. Arthur A. Shurtleff, Landscape Architect. 



212 



THE AMERICAN HOSPITAL 



CENTER, LINE 




FIG. 248. PAVILION— NOVA SCOTIA SANATORIUM, KENTVILLE, N. S. 
Scopes & Feustmann, Architects. 



room will probably not be used, and may 
be omitted. There should be, however, 
a room equipped for doing surgical 
dressings. 

One item peculiar to the care of tuber- 
culosis is the provision for the destruc- 
tion of sputum cups, gauze and dressings 
which have come in contact with the pa- 
tient. This can be a separate building 
where the patient can deliver his sputum 
cup and receive a fresh one, and where 
there is a suitable incinerator for the ab- 
solute destruction of all waste material. 

Open air day shacks or shelters can be 
provided through the grounds at little 
extra expense. There are numerous pat- 
terns and they may even be made revolv- 
ing, like the one photographed by the 
writer in Amsterdam, Holland (Fig. 
232 ) , where the pavilion could be turned 
to shield the patient from sun or wind. 

Of the many good examples of tuber- 
culosis hospitals and sanatoriums, few 
will be here shown, as this subject has 
been so carefully taken up by Dr. 
Thomas S. Carrington in his work on 
"Tuberculosis Hospital and Sanatorium 
Construction."* to whom the writer is 



indebted for many helpful suggestions in 
his own practice. 

A simple solution of the tuberculosis 
ward for the general hospital which was 
designed for the Health Board of the City 
of Jacksonville, is here shown (Figs. 233, 
234). This unit provides for a limited 



* Published by National Association for the Study 
and Prevention of Tuberculosis, 105 E. 22nd St., New 
York. 




FIG. 249. PAVILION— NOVA SCOTIA SANATORIUM. 
KENTVILLE, N. S. 
Scopes & Feustmann, Architects. 



OF THE TWENTIETH CENTURY 



213 



JIXLP1NG PORCH 




rrrrn 



DRESSING ROOMi 




FIG. 250. PAVILION— LOOMIS SANATORIUM, LOOMIS, N. Y. 
Scopes & Feustmann, Architects. 



number of both chronic and incipient 
cases, the administration, food, and laun- 
dry being taken care of in another build- 
ing. This unit is a part of the contagious 
department under the charge of the city. 

The City of New York, through its 
Department of Health, has established at 
Otisville, at an altitude of from eleven 
hundred to twelve hundred feet in the 
Shawangunk Mountains, a most complete 
sanatorium for the care of tuberculosis. 

Various types of construction and units 
were built from a single bed tent house 
to the more pretentious fireproof build- 
ing; but in practically every building the 
sleeping is out-of-doors. Dressing-rooms 
and day-room are provided, which are 
heated certain hours in the day. 

The Department of Charities also pro- 
vides in its hospital work for the care of 
tuberculosis, both in the general hospitals 
on Blackwells Island and in the Sea View 
Hospital on Staten Island. In the latter 
institution (Fig. 235) which, with the ad- 
ditions now being built, will provide for 
two thousand patients, the earlier group 
occupied in 1914 will be used to house 
the chronic or bed patients. The ambula- 
tory patients will occupy the twenty-one 



new pavilions. The institution will then 
be well balanced, accommodating an 
equal number of bed and ambulatory 
cases. The new out-door pavilions are 
built in two groups, the one at the 
southwest to accommodate six hundred 
men, with "group" or executive build- 
ing, and the other at the northeast to ac- 
commodate four hundred women. Din- 
ing facilities for the men will be afforded 
by the new dining hall placed on the main 
axis of the original group, and served by 
the main kitchen. This building (Fig. 
236) also is used for an entertainment 
and assembly hall for patients of both 
sexes. The women will be served in the 
present dining building. 

While the administration of the entire 
group will be from the main administra- 
tion building, the "group" building in the 
center of the male section will contain the 
offices of the medical examiner and 
matron. There are examining rooms, 
pharmacy and treatment rooms, baths for 
men, store, barber shop, dental treatment 
room, recreation rooms and library, as 
well as work rooms for various industries, 
and a linen room where all linen for the 
group will be given out. 



214 



THE AMERICAN HOSPITAL 




FIG. 251. THE OLIVIA COTTAGE-LOOMIS SANATORIUM, LOOMIS, N. Y 
Scopes & Feustmann, Architects. 



The pavilion buildings, twenty-one in 
number, are practically identical (Figs. 
240 and 241). They are two stories 
in height, of fireproof material, divided 
into four sleeping apartments of twelve 
beds each, with each unit of two beds 
separated from the others by a dividing 
screen six feet high, but open on end 
and underneath to permit air circulation. 
These are not heated and are open to the 
south, with possible closing by the use 
of cloth screens on frames hinged at the 
top. 

For each two wards a day room is 
provided, connecting directly with the 
toilet section, beyond which is the locker 
room. Each patient is provided with a 
locker three by four feet, with short door 
and screen ceiling, allowing free circu- 
lation of air but preventing interference 
from outside. 

Two of the units used at the Boston 



Consumptives' Hospital at Mattapan will 
serve to illustrate the various units for 
different treatment of chronic and in- 
cipient cases. The ward building (Fig. 
242) here shown is two stories in height. 
Each unit is divided in the center, and 
the main service rooms are placed be- 
tween the two fourteen-bed wards. Am- 
ple airing balcony space is provided, and 
the unit has proved easy of administra- 
tion. For the more active patients the 
one-story pavilions (Fig. 243) are used. 
This unit is similar to those used in 
other State and City hospitals, and has 
been fully described and classified by Dr. 
Carrington.* Larger locker space is pro- 
vided for the patients, additional airing 
balcony for each bed, an emergency room, 
and a room for the nurse, as well as a 



* Published by National Association for the Study 
and Prevention of Tuberculosis, 105 E. 22nd St., New 
York. 



OF THE TWENTIETH CENTURY 



215 



large day room accessible to each division. 
The building is of wood, in simple, pic- 
turesque style. There are throughout the 
country private sanitoria for the care of 
tuberculous patients who can afford to 
pay for a greater degree of comfort. The 
Central Nezv England Sanitorium, Rut- 
land, Mass., will serve to illustrate this 
type of institution. 

Built upon a beautiful southern slope, 
this group of buildings will when com- 
plete house about eighty patients. The 
main building, facing south, consists of 
three sections, separated by fireproof bal- 
conies. The center section contains : on 
the ground floor (Fig. 244) the kitchen, 
laundry and heating plant; on the first 
floor (Fig. 245) the offices, examining 
and treatment rooms, the lounge, and the 
patients' dining room ; on the second floor 
(Fig. 246) the superintendent's suite and 
guest rooms are at the front, rooms for 
patients' friends, etc., at the rear. The 
main lounge and the dining room extend 
through two stories, and are beautified 
with large fireplaces. 

The three floors of the east and west 
wings, which house the patients, are plan- 
ned to provide for varying degrees of 



luxury. There are single rooms, two-bed 
wards and private suites, all with ample 
outdoor balconies. The utility rooms are 
on the north side. The connecting airing 
balconies provide additional outdoor 
space, and make a fireproof cut-off be- 
tween the three sections. The exterior is 
in Mission style. The construction is of 
hollow tile, with rough plaster finish. 

The plot plan (Fig. 247) indicates the 
broad view of the founder of this institu- 
tion. There will be grouped about the 
main building the industrial and physical 
training buildings, and a considerable col- 
ony of small houses and shacks. 

At the Nova Scotia Sanitorium, Kent- 
ville, N. S. (Figs. 248, 249), there are 
two types of buildings. The one for am- 
bulatory patients is self-contained, having 
open verandas which may be closed in 
storms or severe weather, dressing rooms, 
a sitting room with wide windows, and 
an emergency room. 

The Olivia Cottage, at the Loomis San- 
itorium, Loomis, N. Y. (Fig. 251), pro- 
vides an enclosed portion for sick pa- 
tients, utilities or for severe weather. For 
ambulatory cases in good weather the 
porches are wide-open and airy. 



216 



THE AMERICAN HOSPITAL 



CHAPTER XI. 



TOje laboratories 



The development of the laboratory 
work in the general hospital depends 
largely on the personnel of the staff, the 
proximity to establish independent labora- 
tories, and the possibility of the develop- 
ment within the institution. In the larger 
hospitals, separate buildings away from 
the main group are devoted entirely to 
laboratory purposes, where there are class 
rooms for teaching, autopsy rooms and 
morgue; and often the chapel is con- 
nected with this building. These, with 
the local laboratories in the ward units 
and the operating units, form a chain for 
diagnostic and research work, which is 
every year becoming more and more es- 
sential. Facilities and equipment which 



ten years ago were considered elaborate 
are now thought bare necessities. 

In the small hospital, however, of fifty 
beds or less, where the laboratory work 
is done by members of the staff, it is not 
necessary to provide extensively. Light 
basement rooms will generally serve for 
the purpose, the principal necessity be- 
ing light. There must be space and equip- 
ment for making blood tests, urinalyses, 
examinations of pus, sputum and other 
bacteriological work; and every hospital 
will have its own particular addition to 
the list. In planning laboratories at the 
present time, it should be kept in mind 
that enlargement is almost sure to be 
needed. 




CXXXJ TOHOT 



I. Utility Room. 2. Dark Room. 3. Clothing Locker Room. 4. Waterclosets. 5. Mourners' Waiting Room. 
6. Ante Room. 7, Undertaker's Room. 8. Body Display or Identification Room. 9. Freight Lift. 10. Hall. 

II. Bath Rooms. 12. Roentgen Ray Rooms. 13. Assistant's Room. 14. Entry. 15. Dissecting Room. 



FIG. 252. 



MUNICH- SCHWABING HOSPITAL, MUNICH, GERMANY. 

FIRST FLOOR PLAN. 



PATHOLOGICAL BUILDING. 



217 




1. Museum and Lecture Room. 2. Watercloset. 3. Store Room. 4. Laboratory of the Prosector. 
5. Histological Laboratory. 6. Lift. 7. Incubator Room. 8. Prosector's Room. 9. Library. 10. Reading 
Room. 11. Supply and Instrument Room. 12. Scale or Balance Room. 13. Chemical Laboratory. 

14. Bacteriological Laboratory. 

FIG. 253. MUNICH-SCHWABING HOSPITAL, MUNICH GERMANY. PATHOLOGICAL BUILDING. 

SECOND FLOOR PLAN. 




FIG. 254. MUNICH-SCHWABING HOSPITAL, MUNICH, GERMANY. DISSECTING ROOM. 



218 



THE AMERICAN HOSPITAL 




FIG. 2SS. MUNICH- SCHWABING HOSPITAL, MUNICH, GERMANY. PATHOLOGICAL DEPARTMENT. 

ANIMAL BUILDING. 
Richard Schachner, Architect. 



OF THE TWENTIETH CENTURY 



219 




BASEMENT. 

FIG. 256. PATHOLOGICAL BUILDING, ST. GEORG HOSPITAL, HAMBURG, GERMANY. 



220 



THE AMERICAN HOSPITAL 




FIG. 257. DISSECTION TABLE, ST. GEORG 
HOSPITAL. HAMBURG. GERMANY. 

For the larger research laboratories, 
space for the hygienic care of animals 



used in experimentation must be pro- 
vided, either on the roof of the building 
or even in a separate building ; but if they 
must be kept on lower levels, the rooms 
should receive special ventilation. 

Every hospital, even of fifty beds or 
less, should have a room where autopsies 
can be performed, and suitable equip- 
ment for the same should be furnished. 
This room must be well ventilated, should 
have a flushing floor drain, simple 
autopsy table, with sink and facilities for 
properly handling the body. Good day 
lighting is desirable but not necessary; 
but there must be an abundance of arti- 
ficial light. 

In the larger hospitals in Europe, the 









L 




^ r 

1 f 




1 f 






: fJm 



ttt* rrr - t wt ~ in h ' " i pT v i v~ 



i-L 



FIG. 258. MAYO CLINIC, ROCHESTER, MINN. FIRST FLOOR PLAN. 
Ellerbe & Round, Architects. 



Room 107 1 
Room 10S I 

Room 106 ^Consultation 
Room 108 
Room 110 
Room 103 
Room 109 C. H. Mayo, Consulta- 
tion. 

Room 111 Reception, W. J. and 
C. H. Mayo. 

Room 113 W. J. Mayo, Consulta- 
tion. 

Room 115 
Room 117 . , 

Room 119 rConsultation rooms. 
Room 121 



Consultation rooms. 



Room 123 
Room 125 
Room 127 
Room 132 
Room 134 
Room 138 
Room 136 
Room 140 
Room 144 
Room 146J 
Room 135 Clinical. 
Room 137 Clinical. 
Room 139 Clinical. 
Room 141 Hospital assignment. 
Room 164 Alphabetical index. 
Room 169 Accounts. 



Room 148") 
Room 150 
Room 162 

Room 154 Consultation rooms 

Room 156 
Room 158 
Room 160 
Room 152J 
Room 174^1 

Room m Stenographers. 
Room 168J 

Room Kl Mail distribution. 
Room 175 Dictaphone. 
Room 173 Office. 

Room 177 Office telephone central 



OF THE TWENTIETH CENTURY 



221 



pathological department is under sepa- 
rate management. The plans of the 
Pathological Institute of the Munich- 
Schwabing Hospital are here shown 
(Figs. 252, 253) and are self-explana- 
toiy. The detail and equipment are ex- 
cellent, the dissecting room in particular 
(Fig. 254) showing most careful atten- 
tion to plumbing and outfit. In this in- 
stitution there is a separate building 
(Fig. 255) for animals, with special op- 
erating room perfectly equipped. 

The pathological building at St. Georg 
is another carefully developed depart- 
ment, as the few illustrations will show 
(Figs. 256, 257). 

The Mayo Clinic building, Rochester, 



Minn. (Figs. 258-261), built by the Drs. 
Mayo for their own private work, is in 
effect an out-patient building, but con- 
tains extensive and well-planned labora- 
tories. The whole of the third floor and 
part of the ground floor are given up to 
research. 

Attention is called to the laboratories 
of the Ohio Valley General Hospital, 
Wheeling, W. Va. (Fig. 99), and to those 
in the out-patient departments of the 
Royal Victoria Hospital, Montreal (Fig. 
280), and the Ottazva Civic Hospital, 
Ottawa (Fig. 79). 

The Royal Victoria Hospital, Montreal, 
felt the need of more accuracy in han- 
dling nephritis and other metabolic dis- 




FIG. 



259. MAYO CLINIC, ROCHESTER, MINN. SECOND FLOOR PLAN 
Ellerbe & Round, Architects. 



Room 271 Cystoscopic. Room 

Room 273 Private office, Braasch. Room 

Room 201 Cystoscopic. Room 
Room 203 Cystoscopic. 

Room 205 Refraction. Room 

Room 209 Eye. Room 

Room 209a Eye. Room 

Room 213 Eye. Room 

Room 215 Nose and throat. Room 

Room 221 Nose and throat. Room 

Room 227 Laboratory, bacterio- Room 

logical. Room 

Room 227a Laboratory, parasito- Room 

logical. Room 



232 Clinical. 
228 Clinical. 
226 Clinical, blood 

tures, etc. 
224 Clinical. 
222 Clinical. 
220 Clinical. 
259a X-Ray indexing. 
278 X-Ray viewing. 
249a X-Ray storage. 
249 Fluoroscopic 
249a Fluoroscopic. 
248 Food preparation. 
248a Exposure, X-Ray. 



Room 250 Exposure, X-Ray. 
Room 252 Exposure, X-Ray. 
cul- Room 254 Exposure, X-Ray. 

Room 258c Developing. 
Room 258b Developing. 
Room 264 Exposure. 
Room 268 Exposure. 
Room 270 Exposure. 
Room 274 Exposure. 
Room 275 Private office. 
Room J2b Toilet, men, special, 
public. 

Room J2b Toilet, women, special, 
public. 



222 



THE AMERICAN HOSPITAL 



eases. They therefore set aside a small 
wing which they call their "Metabolism 
Clinic," providing for in and out patients, 
laboratory and kitchen. The laboratory 
makes analyses of blood, urine, gases, and 



food (Fig. 262). 

Filing Space. In all laboratories, ade- 
quate provision should be made for the 
filing of records, plates and specimens, 
and for stenographic or clerical work. 



THE ROENTGEN-RAY DEPARTMENT. 



The Roentgen-ray, in its divers uses, 
plays a most important part in the work 
of every hospital. It has become invalu- 
able in diagnosis. The larger hospitals 
employ a man for this work alone, and 
while it is true that the best results can 
be had only by an expert, no hospital can 
get along without some provision for 
X-ray examinations. There must be fa- 
cilities for dealing with fractures and for 
making stomach and intestinal diagnoses. 
Where a Roentgenologist is employed, 



examinations of many of the soft tissues 
will be required and more extensive pro- 
vision must be made. As with laboratory 
work, a department which ten years ago 
was counted luxurious, is now barely suf- 
ficient for ordinary work. 

A few principles may be mentioned 
in providing for this department : 

In selecting Roentgen laboratory avoid 
cellar, particularly if it is damp ; moisture 
causes trouble with the transformer and 
high tension wiring. 




FIG. 260. MAYO CLINIC, ROCHESTER, MINN. THIRD FLOOR PLAN. 
Ellerbe & Round, Architects. 



Room 377 Editorial. 
Room 303 Editorial. 
Room F3a Toilet staff, men. 
Room 305 Pathological labora- 
tory. 

Room 309 Pathological labora- 
tory. 

Room 313 Stenographic. 



Room 315 Pathological labora- 
tory. 

Room 323 Pathological labora- 
tory. 

Room 325 Pathological labora- 
tory. 

Room 331 Chemical laboratory 
Room 363 Reading. 



Room 320 Pathological labora- 
tory. 

Room 359 Artists' studio. 

Room 355 Coat room. 

Room 349 Assembly room. 

Room 366 Stock room. 

Room 375 Reading room. 

Room 369 Reprints. 



OF THE TWENTIETH CENTURY 



223 



% 
Id 



n 









- 1 mi y 


1 





3^ 




FIG 261. 



Room 401 Store room. 
Room 409-405 Pathological mu- 
seum. 

Room 411 Pathological store- 
room. 
Room 420 Drafting. 



MAYO CLINIC, ROCHESTER, MINN. ATTIC. 
Ellerbe & Round, Architects. 



Room 413 Pathological prep 

tion. 
Room 422 Shop. 
Room 469 X-Ray store-room. 
Room 466 X-Ray machines. 
Room 464 X-Ray dry plates. 



Room 460 Photographic store 
room. 

Room 458 Bromide room. 
Room 453a Developing. 
Room 468 Waiting room. 
Room 453 Photographic gallery. 




224 



THE AMERICAN HOSPITAL 




FIG. 264. ROENTGEN- RAY DEPARTMENT, OHIO VALLEY GENERAL HOSPITAL, 

WHEELING, W. VA. 



OF THE TWENTIETH CENTURY 



225 





FIG. 265. UPRIGHT FLUOROSCOPE. 



The room should be sufficiently high 
studded to allow overhead high tension 
system. 

The X-ray transformer requires a 
special electric current supply. Do not 
rely on the word of a local electrician or 
power company. 

Special precaution should be taken that 
all electric light conduits in Roentgen 
room are properly grounded. 

Arrangements should be made for a 
perfect ground near position of X-ray 
transformer. 

The room to be used for fluoroscopy 
should be so arranged that it can readily 
be made light proof. 

Special lead protection is necessary 
where the Coolidge tube is used for 
X-ray therapy. 

The dark room, for developing and 



loading plates, should be located as near 
the Roentgen laboratory as possible. 

Hot water, as well as cold running 
water, in the dark room is desirable. 

We know that the recurrent use of this 
powerful medium has caused serious 
burns and the destruction of live tissue 
so that the operators should have every 
possible protection. Lead screens afford 
this protecton against both direct and 
reflected rays. It is more common now 
to provide control rooms heavily lined 
with lead at least one-eighth inch thick ; 
and where vision is required, lead glass 
is used for the operator. 

This department should be planned for 
at the beginning, not left to chance. 

Probably there is no more elaborate 
example of the use of the X-ray in diag- 
nosis than at the Mayo Clinic, Roches- 



22o 



THE AMERICAN HOSPITAL 



ter, Minn. (Fig. 259). Half of the sec- 
ond floor of the building is devoted to 
this purpose. 

The Buffalo General Hospital, Buffalo, 
N. Y., has a separate building for its 
Roentgen-ray department (Fig. 263). 
The control room is in the center, and 
around it are situated the two operating 
rooms, a treatment room, fluoroscopic and 
waiting rooms. At the left are the dark 
and loading rooms, developing depart- 
ment, etc. On the right are the filing and 
viewing rooms. 

In the Notre Dame Hospital, Montreal, 
the X-ray department is not large, but is 



quite complete (Fig. 92). The control 
room is between the two operating rooms ; 
there is a good dark room, a viewing 
room, space for storage, etc. 

Attention may be called to the Roent- 
gen-ray departments of the Ottawa Civic 
Hospital, Ottawa (Fig. 79), and that of 
the Royal Victoria Hospital, Montreal, in 
the out-patient department (Fig. 2S0). 
Small departments are shown in the Ohio 
Valley General Hospital, Wheeling, W. 
Va. (Fig. 101), the Youngstown, Ohio 
(Fig. 124) Hospital, and the Barre (Vt.) 
Hospital (Fig. 290). 



OF THE TWENTIETH CENTURY 



227 



CHAPTER XII. 

Gbe ©ut*fl>atient Department. 



Today nearly every large hospital in 
the country has an out-patient and social 
service department, where more or less 
dispensary work is afforded people who 
are not enrolled as patients of the hos- 
pital, or more home care is provided. 

The location of the hospital in the com- 
munity, the likelihood of casualties, and 
the nearness to other dispensaries have a 
bearing on the development of this de- 
partment. Except, perhaps, in the large 
city communities, this dispensary or out- 
patient service can be rendered more ef- 
fectively in connection with the general 
hospital ; for the reason that many of the 
departments can be used in common, such 
as the drug room, the Roentgen-ray de- 
partment, the hydro and mechano-thera- 
peutic departments, the heating plant, 
and, in emergencies, the service of mem- 
bers of the staff and nursing forces. 

The size and shape of this department 
must be governed by the needs and the 
available space. If the call is small, it 
may be placed safely in the basement of 
one or more of the hospital buildings, or 
on certain floors set apart for this 
purpose. 

Mackintosh* says, "The out-patient 
department should be a one-storied build- 
ing, quite apart from the hospital." 

Davis and Warner (f) prefer a two- 
storied, rectangular building with a cen- 
tral light court in the second story. If 
the plot of ground available is restricted, 
the building may be three or four stories, 
but not more than 36 to 40 feet in width. 

Figs. 266 and 267 show an ideal rec- 
tangular plan. In the basement there is 
space for clinical records, lockers and 
lavatories for employes, and if the build- 
ing is independent of a hospital, a drug 
store-room, general store-room, and the 
heating plant. 

Fig. 268 shows one floor of a long rec- 

* "Construction, Equipment and Management of a 
General Hospital," by Donald Mackintosh, M.B. 

■(-"Dispensaries," by Michael W. Davis and Andrew 
R. Warner, Macmillan, 1918. 



tangular plan, for a unit thirty-six feet 
wide. The admitting hall and admini- 
strative department are on the floor be- 
low. (*) 

The L-shaped building often affords a 
better division of departments than the 
rectangle, since the large waiting room 
can be placed at the junction of the two 
wings, giving better supervision from the 
administrative center. 

Davis and Warner set the following 
standards : "In locating an out-patient 
building with reference to the other build- 
ings of the hospital it is to be borne in 
mind that the dispensary may receive 
more patients than all the other parts of 
the hospital put together. Hence its en- 
trance should be as accessible as possible 
from the main streets, and yet not be so 
placed as to interfere with ambulances, 
automobiles, patients or visitors coming 
to the building. It is highly important 
that the laboratories of the hospital and 
the X-ray department shall be accessible 
to the dispensary, so that examinations of 
either kind can be made with the least 
possible transference of patients. 

If the dispensary is located in one wing 
of a group of hospital buildings, it is most 
desirable to have this wing close to the 
main administrative portion of the hos- 
pital. Large numbers of patients are re- 
ferred to and from the dispensary and 
the wards. The record rooms for the 
hospital and dispensary are best managed 
if close together." (f ) 

Principles, Whether this department 
be in a separate building of one story or 
multi-story, or connected with any other 
department, there are certain practical 
principles to be considered. 

The entrance should be large and well 
protected from storms. As many of the 
out-patients are children-in-arms, ade- 
quate provision must be made for peram- 

*These plans were made by the author for Davis 
and Warner's book. 

■{■"Dispensaries," by Davis and Warner, Macmillan 
1918. 



228 



THE AMERICAN HOSPITAL 




5tcoND Floor, Plan 



FIG. 267. RECTANGULAR BUILDING FOR OUT-PATIENT 
DEPARTMENT. 



OF THE TWENTIETH CENTURY 



229 



Connecting Cozjuvotl, 




MtDlCAL AND 5U&GICAL CLINIC 



FetT 



FIG. 268. LONG, RECTANGULAR BUILDING FOR OUT-PATIENT 
DEPARTMENT. 



bulators at or near the street level. 

Where practicable, the exit should be a 
separate door. Near this door can be 
located the laboratory and the pharmacy. 

Near the entrance should be the of- 
fice of the department, the examining 
rooms, and the social workers' office. 

The waiting room should be large, well 
lighted, and above all well ventilated and 
centrally located, with the seating space 
so arranged as to give perfect circulation 
and prevent congestion. There must be 
space for new patients to wait near the 
admitting desk, for old patients until their 
turn comes for examination or treatment, 



and for pharmacy patients while their 
medicine is being prepared. 

Near the preliminary examination desk 
there should be isolation rooms with a 
separate exit, for any suspicious or con- 
tagious case. 

The arrangement and division of de- 
partments may depend on the respective 
service. 

There must be ample room for all clin- 
ical records, so arranged that they may 
be easily and quickly consulted. Addi- 
tional space will be required for future 
records, and for storing those not often 
consulted. 



230 



THE AMERICAN HOSPITAL 




5tCOND FLOOR/ 



FIG. 269. HOUSE REMODELED FOR HEALTH CENTER. 



There must be room reserved for the 
executive offices. 

Laboratory and X-ray departments of 
considerable elaboration are necessary, 
unless those belonging to the hospital are 
available; likewise a good pharmacy. 

In the small service, by the use of dif- 
ferent rooms at different hours and by a 
slight change in equipment, the treat- 
ment of the different diseases can be ac- 
complished ; in fact, splendid work can 
be done in a very small space. But the 
ideal out-patient department should have 
space and divisions for general medical 
clinic, children's clinic, surgical clinic, 
gynecology clinic, venereal clinic, genito- 
urinary clinic, eye-ear-nose-and-throat 
clinic, and dental clinic ; and as the de- 
partment grows, separate space should be 
provided for orthopedic, nervous and 
mental diseases, and for the treatment of 
tuberculosis, whooping cough, and vagi- 
nitis. 



A special clinic may be needed for 
poliomyelitis cases. 

The work of examination and treat- 
ment is facilitated if provision is made 
for patients to wait at or near the treat- 
ment rooms. In some cases, separate 
waiting-rooms or history corridors are 
provided where the assistants can take 
down the history and prepare the patient 
for examination or treatment. 

In providing for the clinics, the larger 
services such as the medical and children's 
services should be located on the entrance 
floor, in order to avoid congestion. The 
orthopedic, with the plaster work and 
brace shop, may well be located in the 
basement. 

As to the size of the treatment rooms, 
there may be a difference of opinion ; one 
man may wish a large room with, per- 
haps, cloth screens dividing the patients ; 
another, a small room opening from the 
general room of that service, where any 



OF THE TWENTIETH CENTURY 





FIG. 271. OUT-PATIENT DEPARTMENT, CHILDREN'S HOSPITAL, PHILADELPHIA, PA. 



232 



THE AMERICAN HOSPITAL 




FIG. 272. PROPOSED OUT-PATIENT DEPARTMENT FOR NEW YORK CITY. FIRST FLOOR. 

Designed by S. S. Goldwater, M.D. 



conversation will not be overheard by the 
patients nearby. If the small room is 
used, the ventilation should be assured 
and positive. If the rooms are to be used 
for teaching purposes, they should be of 
larger size. 

In the surgical department, there 
should be the complete operating room 
with its adjuncts — the sterilizing and 
anaesthetic room ; and as many of the 
minor operations are performed under 



anaesthetics, recovery rooms should 
also be provided. 

Each clinical division should be made 
a complete working unit, with proper 
plumbing fixtures, cabinets, and supplies 
for disinfecting against contagion, and 
apparatus for sterilization of instruments, 
etc. 

The waiting room should not be void 
of artistic merit, for even with the out- 
patient, the environment should tend to 




FIG. 273. PROPOSED OUT-PATIENT DEPARTMENT FOR NEW YORK CITY. SECOND FLOOR. 

Designed by S. S. Goldwater, M.D. 



OF THE TWENTIETH CENTURY 



233 



oenefit the mind as the treatment does 
the body. 

"Hospital finish" is necessary, since 
numbers of people mean much dirt, and 
cleaning must be made easy. The floors 
get much harder use than those in the hos- 
pital ; they should be non-absorbent and 
readily scrubbed. The walls, ceilings and 
furniture should be of simple design and 
easily cleaned. 

Good lighting, both for day and night, 
is essential. 

Even a two-story building should have 
an elevator, for cardiacs, feeble, lame, 
mothers with babies to carry, etc. 

Drinking water should always be avail- 
able. (*) 

Davis gives the following list of rooms 
needed in a small out-patient department. 
(1) Admission hall, with booths for ad- 
mitting, records and social service. (2) 
Pharmacy. (3) Medical clinic, two 
rooms, or one with a booth partitioned 
off. (4) Surgical clinic, three rooms. 
(5) Children's clinic, one room. (6) 
Eye, ear, nose and throat clinic, two 
rooms. (7) Dental clinic. 

He also gives a plan for remodelling a 
house so that it can be used as a health 

* Further elaboration of these points will be found 
in Davis and Warner's book, in the chapter on 
buildings. 



center and dispensary combined (Fig. 
269). 

A more complete out-patient depart- 
ment is hardly to be found than that of 
the Western Infirmary at Glasgow 
(Fig. 270). From the time the patient 
enters until he leaves, it is not necessary 
for him to cross his own path. He finally 
comes up in front of the dispensary and 
goes thence to the exit. 

At the entrance is the preliminary wait- 
ing-room for new patients, with its isola- 
tion and diagnosis room; then the large 
central waiting; the special treatment 
room for eye, ear, nose, and throat; for 
minor dressings ; and the various surgical 
and medical clinic rooms, with dressing- 
rooms connected ; each unit a teaching 
theatre, with circular benches for stu- 
dents, with the dispensary near the exit. 

A special students' entrance is pro- 
Aided, with corridor above and exit pas- 
sage, connecting with each of the clinic 
rooms. 

The first building of the Children's 
Hospital, Philadelphia, as planned, is 
for out-patients. Entrance is through a 
large vestibule arranged for the storage 
of baby carriages. A record office fills a 
commanding position. The babies' dispen- 
sary, with examining rooms and a milk 




FIG. 274. PROPOSED OUT-PATIENT DEPARTMENT FOR NEW YORK CITY. THIRD FLOOR. 

Designed by S. S. Goldwater, M.D. 



234 THE AMERICAN HOSPITAL 












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o 




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u- 




o 








1 


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1 


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3 








1 






1 




0 








-1 
< 







OF THE TWENTIETH CENTURY 



235 



and duty room adjoining, occupies the 
central position in the rear of the record 
desk. The medical and surgical examin- 
ing rooms use the rest of the first floor 
(Fig. 271). 

The plans show in the basement the 
detention room for suspected cases, a 
whooping-cough clinic having a separate 
entrance. The X-ray, orthopedic, and 
plaster rooms are on this floor. The eye, 
ear, nose, and throat treatment and utility 
rooms are on the second floor ; also the 



operating and recovery rooms. The third 
floor is occupied by the laboratories. 

The plan of an ideal out-patient depart- 
ment suggested by Dr. S. S. Goldwater 
in Mr. Henry C. Wright's* report on City 
Departments of New York, shows the 
working out of a three-story out-patient 
department on a restricted city site with 
buildings adjacent. The plans (Figs 272, 
273, 274) show the possibilities of such 

* Report of Committee on Inquiry into Hospitals 
and City Homes of New York City. 




236 



THE AMERICAN HOSPITAL 



a site and the placing of the rooms and 
corridors to conserve light, assure circu- 
lation, and afford ease in the handling of 
patients. 

The small out-patient department (Fig. 
275) of the Macon Hospital, where the 
problem of serving the colored as well as 
the white must he met, shows the possi- 
bilities of even a Miiall unit. 

The waiting-rooms for both white and 
colored are supervised from one desk. 
The treatment rooms, however, are not 
divided. A complete operating depart- 
ment is here provided, which will serve, 
to a certain extent, for minor operations 



for the colored patient, the wards foi 
whom are on the second and third stories 
of this building. 

The dispensary building for the East 
TSfew York Hospital, for the time being, 
will serve for dispensary and hospital. 
As shown by Figs. 276 and 277, a por- 
tion of the ground floor and all of the 
second will be used for out-patient ser- 
vice. Worked out on the "L" plan, with 
the waiting-room at the junction of the 
two wings and with the administration 
and examining rooms, the social service 
office, the pharmacy, and the laboratory 
in central locations, the problem of car- 



238 



THE AMERICAN HOSPITAL 




FIG. 279. FIRST FLOOR, OUT-PATIENT DEPARTMENT-ROYAL VICTORIA HOSPITAL, 

MONTREAL, QUEBEC. 
Stevens & Lee, Architects. 




FIG. 280. SECOND FLOOR, OUT-PATIENT DEPARTMENT-ROYAL VICTORIA HOSPITAL, 

MONTREAL, QUEBEC. 
Stevens & Lee, Architects. 




FIG. 281. THIRD FLOOR, OUT-PATIENT DEPARTMENT-ROYAL VICTORIA HOSPITAL, 

MONTREAL, QUEBEC. 
Stevens & Lee, Architects. 



OF THE TWENTIETH CENTURY 



239 




fctYAL • VlfTOB-IX - Ho/piTAL 

FIG. 282. FOURTH FLOOR, OUT-PATIENT DEPARTMENT— ROYAL VICTORIA HOSPITAL, 

MONTREAL, QUEBEC. 
Stevens & Lee, Architects. 



ing for the patients should be simple. 
The X-ray and hydro departments are on 
the ground floor. 

While the in-patient work of the Hos- 
pital for Sick Children, at Toronto (Fig. 
278), and the work at the Lakeside Home 
is tremendous, the out-patient work and 
the milk dispensary work are even greater. 
The entire ground and first floors of the 
new contagious wing and a large portion 
of the first floor of the old building are 
used for the out-patient work. The main 
waiting-room connects at the left with the 
pharmacy; the laboratories at the rear 
with the hospital and pasteurizing plant 
and at the right with the various depart- 
ments including medical, surgical, eye, ear 
and throat, orthopedic, etc., while in the 
basement is a large measles clinic, and the 
brace and mechanical shops for making 
of apparatus. 

The Mayo Clinic, Rochester, Minn. 
(Figs. 258-261), is a private out-patient 
building. The first floor is devoted to 
consultation rooms, the second to X-ray, 
microscopic work and to special exam- 
ining rooms, eye, ear, nose, throat, cysto- 
scopic, procotoscopic, etc., including pro- 
vision for treatment. The third floor 
contains the pathological laboratories and 
the library. The fourth floor houses the 
pathological museum, the X-ray develop- 
ing and storage, and various workshops. 
The roof contains the animal houses and 
experimentation laboratories. This is 
doubtless one of the best buildings of its 



sort in the country and may repay study, 
for its content, if not for its elaboration.* 

* A detailed description appeared in the Journal- 
Lancet, August, 1914. 




FIG. 282A. OPERATING BUILDING, 
YOUNGSTOWN HOSPITAL, 
YOUNGSTOWN, OHIO. 

Edward F. Stevens, Architect. 
Stanley & Scheibel, Associate Architects. 



OF THE TWENTIETH CENTURY 



241 



At the Royal Victoria Hospital, Mon- 
treal, Canada, the building formerly used 
for pathological work has been remodelled 
for out-patient service (Figs. 279-282). 

The large waiting room on the first 
floor is the center, with office, pharmacy 
and a special isolation room for suspected 
cases near by. Roth in and out patients 
are admitted here. The second floor 
provides history-taking and examining 
rooms, dental clinic, neurological clinic, 
and the X-ray department. On the third 
floor are waiting room, operating room 
and dressing rooms for surgical and 
gynecological cases. There is also a 
large children's ward, partly open and 
partly with cubicles for isolation. On the 
fourth floor is the orthopedic department, 
with plaster and treatment rooms. The 
eye, ear, nose and throat clinics are here, 
the latter having a specially-designed 
booth for treatments (Fig. 417). There 
is a recovery ward for tonsil and ade- 
noid cases, near the children's ward of 
the main hospital. 

The plan of the out-patient department 
of the Ottawa Civic Hospital, Ottawa, 
provides for a considerable service (Fig. 
79). It is divided into many small units 
for examination and treatment. There is 
a plaster room, a genecological treatment 
room, a dental clinic, a special department 
for eye, ear, nose and throat. Rooms for 
the operation of tonsil and adenoid cases 
and for their recovery are provided. 

The Robinson Memorial of the Mas- 
sachusetts Homeopathic Hospital, Ros- 
ton (Figs. 160, 162), contains an excel- 
lent out-patient department. In the 
Youngstown Hospital Youngstown, O., 
the department is small, but planned for 
the needs of this particular hospital (Fig. 
282A). Examples of other small depart- 
ments will be found in the Ohio Valley 
General Hospital, Wheeling, W. Va. 
(Fig. 99), and in Dr. Williams' private 
sanitarium, at Macon, Ga. (Fig. 285). 

Industrial First- Aid Buildings. There 
is now hardly a factory or shop of any 
size without some form of first-aid 
equipment. Many factories and mills 
have rooms set apart for first-aid and sur- 
gical dressings, with a doctor or a nurse 
in attendance ; some provide a place where 






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a) m 

0 









o< 

O c 




the mother-worker can bring her baby 
and have it cared for under wholesome, 
hygienic conditions. A building which 
combines these two functions is shown 
herewith (Figs. 283, 284). It is planned 
to be built on the spacious grounds of a 
Massachusetts cotton mill, and will serve 
four purposes : ( 1 ) for dressings and 
minor accidents; (2) for recovery and 
rest rooms ; (3) as a creche for the babies 
of the workers; (4) for a mothers' room. 



242 



THE AMERICAN HOSPITAL 



From the mill yard one enters the main 
waiting room, which occupies the entire 
width of the building. Next this is the 
dressing room, equipped for minor sur- 
gical work of many sorts. There are two 
small wards or rest rooms, each equipped 
with hot and cold watei ; there are toilets 
and supply closets. 

( )n the second floor, reached hy the 
staircase or a bridge from the mill, is 



the creche or nursery. Here a mother 
may have her baby cared for under the 
direction of a nurse. Adjoining the nur- 
sery is a mothers' room. An airing bal- 
cony increases the capacity and adds to 
comfort in the warmer months. The 
exterior walls and the porch floors are of 
brick. The flat roof is of mill construc- 
tion, slightly camouflaged by projecting 
rafters. 



&l)e Social g>erbtce department 



W hile the social service work in con- 
nection with hospitals and out-patient 
departments is a development of recent 
years, nevertheless it has become a most 
important and necessary adjvtnct. It is 
truly a twentieth-century development, 
starting in Boston in 1905 through Dr. 
Richard Cabot, who introduced the so- 
cial worker as a means of securing more 
accurate diagnosis and rendering more 
effective treatment. 

The social worker co-operates with the 
clinician. Together they take the history, 
one examines the patient, the other "in- 
vestigates the social cause of the ailment." 
The physician prescribes ; the social 
worker "follows up" the homelife, sees 
that the instructions of the physician are 
carried out, and encourages better home 
environment. It is obvious that if the in- 
structions of the medical man in the clinic 
are not carried out, the time is wasted and 
the patient returns without benefit. The 
social service worker renders here invalu- 
able service to the hospital, to the dispen- 
sary, and to the public. 



A very large number of hospitals have 
added this department, and their number 
is increasing rapidly. No new hospital 
should be built, nor an addition made to 
an existing building", without provision 
for it. 

The chief requirements for social ser- 
vice offices are : 

1. They should be easily accessible 
from the out-patient department, and 
from the admitting department of the 
hospital proper. 

2. The department should be divided 
into small rooms (not booths), so that 
all interviews may be strictly private. 

3. There should be space for filing 
cabinets, easily accessible to all the in- 
terviewing rooms. These cabinets should 
be locked when not in use, as the records 
are confidential. 

4. There should be space for a clerk 
or stenographer outside the interviewing 
rooms. The record cases and the stenog- 
rapher's desk may be in the waiting room. 

5. Opportunity for expansion should 
be afforded. 



OF THE TWENTIETH CENTURY 
CHAPTER XIII. 

TOje g>mall hospital 



The development of the small hospital 
is largely American. While the village 
or small hospital may have started in 
England, as stated by Taylor,* the greater 
development has been in this country. 
One can find hundreds of well-planned 
hospitals of fifty to one hundred beds ; 
but for the smaller private hospitals, one 
is more likely to find the adaptation of 
some dwelling, doing good service but 
handicapped at every turn for lack of 
conveniences for economical and efficient 
work. 

Every hospital must have its begin- 
ning ; few indeed can start with a com- 
plete equipment ; so the remodelled 
house should be looked upon as the step- 
ping stone to something more complete. 
See Chapter XX. 

It generally happens that before the 
house has been fitted for hospital pur- 
poses, enough money is expended to go 
far toward building a suitable, up-to-date 
institution. Even then there will be 
waste and unavailable room, which must 
be heated and taken care of. The finish 
which is attractive and necessary for a 
residence becomes almost a menace in a 
hospital. The staircases and halls are 
generally narrow, the rooms are not 
properly ventilated, the toilets are badly 
arranged, and the floor materials are not 
suitable. In other words, an undue 
amount of energy must be expended in 
the housekeeping for such a building, 
and this will detract, in all probability, 
from the care of the patient. 

The same standards of number and 
size of utilities are not applicable to a 
fifteen-bed that would be suitable for a 
fifty-bed establishment, for it would be 
all utilities, with no room for patients. 

In the very small hospital there is not 
the need for the separation and segrega- 
tion of utilities ; one room may serve for 
toilet, sink and bath ; food may be taken 

•Bfickbuilder, January, 1904. 



directly from the kitchen to the patient; 
the operating room may serve for both 
surgical and maternity work. 

Even in the small hospital the life of 
the patients should be safeguarded ; and 
the construction, the egress, the careful 
consideration of the patient are just as 
important as in a large plant. Fireproof 
construction may not be absolutely nec- 
essary but is always desirable, and is 
generally an economy in the end. 

It is possible, however, to meet mod- 
ern requirements in the small village 
hospital and at moderate expense, and the 
examples following will show the solu- 
tion here of several problems. However 
small, each institution must be balanced 
for its special location and purpose. 

In the Dr. Williams' Private Sana- 
torium, Macon, Ga. (Figs. 285-287), the 
problem was to provide for the care 
of both medical and surgical cases, for 
offices, and for an out-patient department 
for colored people. 

The contour of the land gave the 
advantage of being able to place kitchen, 
dining-room, and store rooms in the base- 
ment and still get proper light. 

The first floor is occupied by offices, re- 
ception room, out-patients' clinic, ambu- 
lance entrance, and rooms, service and 
airing balcony for six patients. The am- 
bulance entrance room and clinic oppo- 
site are made sufficiently large so that 
minor dressings may be done here, or 
even a slight operation in a septic case 
which one would not wish to take to the 
main operating room. The elevator and 
stairway to the second floor are near 
this entrance. 

Though small, the operating depart- 
ment on the second floor is complete. 
There is the operating room, surgeons' 
scrub-up room, anaesthetizing room, and 
sterilizing room, with complete equip- 
ment. This department is in a wing on 
the north side of the building and is en- 




FIG. 285. WILLIAMS' PRIVATE SANATORIUM, MACON, GA. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



245 




FIG. 286. WILLIAMS' PRIVATE SANATORIUM, MACON, GA. 
Edward F. Stevens, Architect. 



246 



THE AMERICAN HOSPITAL 




FIG. 287. WILLIAMS' PRIVATE SANATORIUM, MACON, GA EXTERIOR. 
Edward F. Stevens, Architect. 



tirely shut off from the rest of the hos- 
pital. 

On the main floor with the operating 
room are eight private rooms and a 
three-bed ward ; also the necessary utility 
rooms. All rooms occupied by patients 
are located on the south and west. An 
airing balcony of sufficient size to ac- 
commodate all patients is placed on each 
story, on the southeast side of the build- 
ing. 

The nurses are accommodated in a 
separate building nearby. 

This is a complete hospital of seven- 
teen beds, which cost less than twenty- 
five thousand dollars, with all modern 
details, ready for furnishing. 

A unique problem presented itself in 
planning the little hospital for the New 
England Deaconncss Association, in Con- 
cord, Mass. ( Figs. 288-289). Only ten or 
twelve beds were wanted, but sufficient 



accommodation was demanded of the 
kitchen for summer tent work, and an 
additional private ward which was added 
two years later. 

The site is almost ideal, being on a 
slight eminence, with a level plateau 
stretching to the south, pine trees at the 
back, and an extended view of river and 
hills. 

The first floor of the original or north 
building constituted the hospital. The 
front is north, and, therefore, is taken 
up with the combination reception room 
and office, and with the utilities. In the 
eastern extension, shut off from the main 
hospital, is the operating suite, consist- 
ing of operating room, sterilizing room, 
anaesthetizing room, and surgeons' 
scrub-up room. The south and west 
sides are devoted to the rooms of pa- 
tients. An airing balcony extends the 
entire width of the south front, and every 



OF THE TWENTIETH CENTURY 



247 



■SOLAGIUM 




Roon*7 I I Roon*8 




FIG. 288. DEACONESS HOSPITAL, CONCORD, MASS. 
Edward F. Stevens, Architect. 



248 



THE AMERICAN HOSPITAL 




FIG. 289. DEACONESS HOSPITAL, CONCORD, MASS. 

Edward F. Stevens, Architect. 



EXTERIOR. 



ward and private room opens directly 
upon the balcony. There is an incline 
from the balcony to the ground so that 
patients may be wheeled down; easy 
service to the tent wards is thus 
secured. There were two private rooms, 
now used as reception rooms, a two-bed 
ward, a three-bed ward, and a four-bed 
ward. 

The basement is devoted to domestic 
purposes, with kitchen, nurses' dining- 
room, storage for supplies, heating plant, 
and a small hand laundry. 

The second story, in the gambrel roof, 
provides sleeping accommodations for 
the superintendent, four nurses, and 
three servants, all in single rooms, with 
a pleasant sitting-room at the west. 

As high pressure steam or gas was not 
available here, electricity was employed 
for the diet kitchen and for sterilizing. 

The original hospital building is fire- 



proof and cost, ready for occupancy, less 
than twenty thousand dollars. 

The small private pavilion, accommo- 
dating eight private patients, relieves the 
original building and affords room for 
the increasing demand. 

The second story of the new wing, also 
fireproof, occupied temporarily by nurses, 
is so constructed that with slight altera- 
tions the private service can be increased 
to sixteen beds. 

A small city hospital, where the ground 
is more or less restricted, certainly should 
consider only fireproof structure. 

The Bar re (Vt.) City Hospital (Figs. 
290-293) is another solution of the small 
hospital problem. Located on one of the 
hills overlooking the city and taking ad- 
vantage of the southeasterly slope for 
sunlight and air, the simple brick build- 
ing with its broad brick porch bids wel- 
come to the visitor or patient. 



OF THE TWENTIETH CENTURY 




FIG. 290. BARRE CITY HOSPITAL, BARRE, VT. 
Edward F. Stevens, Architect. 




f TtCOL PLAN' 



FIG. 291. BARRE CITY HOSPITAL, BARRE, VT. 
Edward F. Stevens, Architect. 



250 



THE AMERICAN HOSPITAL 




FIG. 293. BARRE CITY HOSPITAL, BARRE, VT. 
Edward F. Stevens, Architect. 



OF THE TWENTIETH CENTURY 



251 



• — 1 



D P 



DA^LritLMT Flooe Plapi 

3C»LL 



FIG. 294. BENJAMIN STICKNEY CABLE MEMORIAL HOSPITAL, IPSWICH, MASS. 
Edward F. Stevens, Architect. 



F * 

O 



Paticmt.3' Tceracc 




FIG. 295. BENJAMIN STICKNEY CABLE MEMORIAL HOSPITAL, IPSWICH, MASS. 
Edward F. Stevens, Architect. 



252 



THE AMERICAN HOSPITAL 



hn_ 1 



E 



AiEinG Dalcomy 



NUBSCS' 

-5iTTin<j Roori 



D 



'Boon Boon'p'i 



PATICnTi' CORBIDOE 



JtBVICL 
MTCHCM 



'n 




FIG. 296. SECOND FLOOR PLAN, BENJAMIN STICKNEY CABLE MEMORIAL HOSPITAL, 

IPSWICH, MASS. 
Edward F. Stevens, Architect. 



On the entrance level or ground floor 
are located the administration, the heat- 
ing and kitchen departments, as well as 
the Roentgen-ray and laboratory depart- 
ments ; and, with the easterly side wholly 
above ground, light and air are not sacri- 
ficed. 

The grade permits entrance to the first 
floor on the westerly side, where the am- 
bulance door is located. 

With all the general offices and utili- 
ties placed on the ground floor, the first 
and second floors are left free for the 
care of patients. 

In planning this hospital no large 
wards were provided, for it was felt that 
a better segregation could be obtained 
with smaller wards. On the first floor 
were located four three-bed wards, seven 
single wards, and a small maternity de- 
partment, entirely isolated, with delivery 
room, creche, and bathing department. 

The second floor is almost wholly de- 
voted to private patients and consists of 
one four-bed children's ward and nine 
private wards. A complete operating de- 
partment is also provided on this floor, 
composed of two operating roms, an- 
aesthetic room, nurses' work room, ster- 
ilizing room and surgeons' locker rooms, 
all shut off from the patients' quarters 
and planned for the most efficient 
service. 

On each floor ample serving kitchens, 
sink rooms, bath and toilet rooms, linen 



storage closets, medicine closets, and 
nurses' stations are provided. 

Large airing balconies at the south af- 
ford opportunities for patients to be 
wheeled into the open air. All doors are 
wide enough for beds, and all beds are 
provided with trucks, while the elevator 
connects all floors. 

Perhaps the most interesting feature 
of this thirty-two-bed hospital is the ex- 
tensive roof ward, equipped with all the 
conveniences and accessories of indoor 
wards and commanding a wonderful 
view over the city and the adjoining hills. 

The materials of construction are 
common brick, granite and terra cotta, 
with floor construction of iron and con- 
crete ; the interior walls of hollow tile; 
the finished flooring is of terrazzo, ce- 
ment, and linoleum ; the finish is simple, 
the windows wide, and the coloring of 
the inside cheerful and attractive. The 
equipment is simple, but fulfills every 
requirement of modern science. 

Differing from the last example, where 
the grounds were more or less restricted, 
the Benjamin Stickney Cable Memorial 
Hospital (Figs. 294-298), in Ipswich, 
Mass., is erected in the center of a ten- 
acre lot. (See Chapter XIX on land- 
scape architecture). The ample space 
around the building, coupled with the 
natural beauty of the site, gives the archi- 
tect more than usual opportunities for 
placing the rooms to the best advantage. 



OF THE TWENTIETH CENTURY 



255 




The building faces the north, or toward 
the town proper, but practically all the 
rooms for patients are on the south, over- 
looking the beautiful valleys and hills in 
that direction. 

The building, of fireproof materials, is 
designed in the early Georgian style so 
common in the old New England towns. 
It accommodates twenty patients on the 
first floor, and the second floor is also 
available for use of patients. 

The ground floor contains the kichen, 
dining-rooms. X-ray, morgue, heating, 



and storage rooms; for the present, the 
second story is set apart for nurses and 
for a small isolation department. 

To give assurance of security, a low 
brick wall is built around the patients' 
court, upon which three airing balconies 
open. These airing balconies, projecting 
to the east and we>t, cut off the cold 
winds from the north and east. 

The plan is simple : one enters through 
the memorial entrance, which is finished 
in Colonial detail, passes up two steps 
to the main corridor and thence into 




THE QE.EENVJLLE HOSPITAL 
Slcohp- Floor Plan GREENVILLE MAINE 



FIG. 300. 



256 



THE AMERICAN HOSPITAL 



r 



J)ECVICE 

Building 



Kitchen 



Operating 
Dept 



Pavilion 



Connecting CoctiDoa. 



ADMINISTRATION 



Plot Plan 

MELft.O^E HO-iJMTAL. 
MELA0.5E ( ■ 

EDWAHDF iTE-XENi ACCHITtCT 

Ronton . ■ — < 



Lebanon 5t^let 



FIG. 301. 



the private patients' day room, or out 
into the patients' court (Figs. 23 and 
2,2 A). 

On the east end of the building is 
located the men's ward, the operating 
department, and the ambulance entrance; 
on the west, the women's and maternity 
wards ; on the northeast, the children's 
ward ; on the south are four private 
rooms ; and on the north the utilities. 

The small Greenville Hospital (Figs. 
299. 300), at Greenville. Me., built to 
meet the needs of the lumber industries 



of the vicinity, at the figure, approx 
imately, of twenty-five thousand dollars, 
is, perhaps, as complete as any hospital 
of a like cost. It is somewhat unduly 
expensive, but was built in the season of 
1916-1917 when all materials were at a 
maximum. 

The problem on the Melrose Hospital 
(Figs. 301-308) at Melrose, Mass., was 
to build a fifty- to sixty-bed hospital on 
a noisy street corner, with trolley lin?s 
on two streets. 

The buildings were set well back from 



OF THE TWENTIETH CENTURY 



257. 




the street, the operating portion only be- 
ing near the street, the buildings being 
so planned as to bring the patients away 
from the noisy corner. There are three 
buildings in this group. 

In the basement of the administration 
building are the Roentgen-ray and 
laboratory departments, the pharmacy, 
store rooms, autopsy and lecture rooms, 
and rooms for male help. On the first 
floor are all of the administrative offices, 
the superintendent's suite, and the oper- 
ating department. 

The second floor, however, is devoted 
to the care of patients — 1st, in private 
rooms and suites; and 2d, in the ma- 
ternity department, which consists of a 
three-bed ward, a delivery room, creche, 
and wash room — all isolated from the 
other portions of the hospital. 

One serving kitchen serves all patients 
in this building. 



The ward pavilion is joined to the ad- 
ministration building by a well-lighted 
corridor. On the first floor are the three 
main wards — men's, women's and chil- 
dren's — and five private rooms, and on 
the second floor are ten private rooms, 
with the usual service. 

All of the wards and private rooms 
on the first floor open directly onto air- 
ing balconies, which are so separated 
that the patients on one balcony are not 
visible to those on another. 

On the second story a large roof ward 
has been provided for the treatment of 
pneumonia cases, as well as for use by 
ambulatory cases. 

The heating plant and laundry are 
housed in a separate building, which also 
affords sleeping accommodations for fe- 
male servants. The nurses are pro- 
vided for in an adjoining estate. 

The problem of the Josiah B. Thomas 



258 THE AMERICAN HOSPITAL 



ADMINISTRATION BUILDING 
HEL^OJE - HOSPITAL 
KELtOSE - 

£l>WAO T jTEVEK.5 ARCHITECT 
fco^TON ■ ' 




" [1 

CHH [itLttl 


Q □ 0 


P 


— — M £ 


□ 




Cnu.DMN'1 
VEiTIBUlt 


CHILDtENi 
WAt_!> | 1 . 


AltING 

1 Ealccw 


ChilMEH' 


ODD 


1 



Pavilion 
Melhoje ~ Hojpital 
Melhoje - Ma^5 

E&WAtD Y JTEVEN.S ARCHITECT 
&O.JTON ■ . 



Fic^t Floo*_ Jlan 

FIG. 304. 



OF THE TWENTIETH CENTURY 



259 





FIG. 306. MELROSE HOSPITAL, MELROSE, MASS. EXTERIOR. 
Edward F. Stevens, Architect. 



/ 



260 



THE AMERICAN HOSPITAL 




FIG. 307. MELROSE HOSPITAL, MELROSE, MASS. OPEN AIR CORRIDOR. 
Edward F. Stevens, Architect. 



Hospital (Figs. 309, 310), at Peabody, 
Mass., was different. The land sloped to 
the north, making that exposure the 
important one to study. The operat- 
ing room window was made the archi- 
tectural feature. Otherwise the build- 
ing is a simple treatment of the small 
hospital problem. A very complete out- 
patient department was secured under 
the surgical end of the building. 

As in the case of Dr. Williams' Sana- 
tarium at Macon, the Mason Hospital 
(Figs. 312, 313), at Clarksburg, W. Va., 
was mainly for the private practice of the 
founder. 

The hospital is built on a somewhat 
restricted site. 

The plans are self-explanatory. Pro- 
vision is made for a rather extensive 
out-patient department in connection 
with the X-ray and laboratory. The 
operating department is set apart from 
the administration, and is reached either 
from the ambulance entrance at the rear 
or through the main entrance at the 
front. 

This small fireproof hospital is self- 
contained, housing all departments except 
the nurses. 



The Yonkcrs Homeopathic Hospital, 
Yonkers, N. Y. (Figs. 317, 318, 319), in- 
cludes wards and private rooms, a large 
maternity department, operating depart- 
ment, kitchen, dining-rooms, and tempor- 
ary housing for domestics. 

The Good Samaritan Hospital, San- 
dusky, Ohio (Figs. 320, 321, 322), is 
a very complete small hospital. On the 
ground floor are the laboratory, X-ray, 
medical treatment rooms, isolation rooms, 
kitchen and dining-rooms. On the first 
floor is the administration department, 
well separated from the wards for men, 
women and children. On the second floor 
are the operating rooms, grouped about 
a rotunda, a small maternity department, 
and sixteen private rooms. Good bal- 
conies are provided for each floor. 

No more fitting memorial could be 
erected to the men who fought in the 
world war than a hospital building. The 
public-spirited citizens of Penn Yan, 
N. Y., chose this form of expression for 
their gratitude. The Soldiers' and Sail- 
ors' Memorial Hospital (Figs. 323, 324, 
325), set in a beautiful park, has for 
its entrance a memorial hall. Its walls 
will have bronze tablets set into the panel- 



OF THE TWENTIETH CENTURY 



261 




FIG. 308. MELROSE HOSPITAL, MELROSE, MASS. PRIVATE ROOM. 



TH L ■ JC5IAH • E> -THOMAS ■ H03P1 TAL- 

FLADODY . ?\A£ SACUOS LTTJ). 




Pla^i Or first. Flood 



FIG. 309. 



262 



THE AMERICAN HOSPITAL 



■THE • J05IAH* £> -TflOmA - H03PITAL,- 




PLA^L OF Sl,COKV FLOOR 




FIG. 311. JOSIAH B. THOMAS HOSPITAL, PEABODY, MASS. 
Kendall, Taylor & Stevens and Edwards F. Stevens, Architects. 



OF THE TWENTIETH CENTURY 



263 



UPPER, -PAE.T of. boiLEU ItooM 



t 



AtUBULtNCE. 
EnTIUNCE 



□ EZ) 

Kitchen /fecial Piet| 



A 



Pa/tr.y Ex>om i 



c o e- r>. i r o a. 



/twlNS 
LIN EN R.OOM 



L_ I" 



Kitchen /-rout/ 



Nue./e/ Pining Coom 



| Jte 

/TO 



Ghounp Floor. Plan 



K.A&E. 



Trtt Ma/on Ho/pi tal 

CLAB.K/BU&G ~ WE/T ViB&lNIA 

tpwACP F" /TtVEN/ - AccnlTtCT 
Boy TON- MA// 



FIG. 312 




FIG. 313. MASON HOSPITAL, CLARKSBURG, W. VA. 
Edward F. Stevens, Architect. 



THE AMERICAN HOSPITAL 





foue,™ rLooaPLAN Tttt Ma/on Ho/tital 

t « «" ■» ™ CLACK/3UHG - Wt/T VIRGINIA 

tPwAjtD r /TtvtN/ - AecniTtCT 

FIG. 315. 



266 



THE AMERICAN HOSPITAL 





PIG. 317. YONKERS HOMEOPATHIC HOSPITAL, YONKERS, N. Y. 
Kendall, Taylor & Stevens, Architects. 




FIG. 318. YONKERS HOMEOPATHIC HOSPITAL, YONKERS, N. Y. 
Kendall, Taylor & Stevens, Architects. 



270 



THE AMERICAN HOSPITAL 




ling, bearing the names of 650 soldiers 
and marines who served in the war. There 
will be cabinets for war relics, etc. From 
this hall, one enters the hospital office 
and staff room, which are cut off from 
the hospital proper. 

The capacity of the hospital is but 
eighteen beds. There is a complete oper- 
ating department on the first floor at the 
north, the maternity being on the south. 
The ambulance entrance is at the rear. 
The contour of the ground gives suffi- 
cient height in the basement for kitchen, 
dining-room and X-ray, as well as the 
heater and store rooms. On the second 



floor are four two-bed wards and five 
private rooms, with ample utilities and 
large balconies. The building is so ar- 
ranged that future additions can be easily 
made. 

The Wallace Thomson Hospital, 
Union, S. C. (Figs. 326, 327, 328), is on 
a commanding site, sunny, away from 
business and traffic. The exterior is in 
southern colonial style, of red brick, with 
white trimmings and a red tile roof. The 
first floor is devoted to the administrative 
and surgical departments, the second be- 
ing reserved for patients. The operating 
and X-ray departments are quite com- 



OF THE TWENTIETH CENTURY 



271 




Courtesy "Architectural Record." 

FIG. 323. SOLDIERS' AND SAILORS' MEMORIAL HOSPITAL, PENN YAN. N. \. BASEMENT. 

Edward F. Stevens, Architect. 




272 



THE AMERICAN HOSPITAL 




Courtesy "Architectural Record." 

FIG. 324A. SOLDIERS' AND SAILORS' MEMORIAL HOSPITAL, PENN YAN, N. Y. SECOND FLOOR. 

Edward F. Stevens, Architect. 




OF THE TWENTIETH CENTURY 



275 




FIG. 328. WALLACE THOMSON HOSPITAL, UNION, S. C. 
Edward F. Stevens, Architect. 



plete ; the staff room is used as a surgeons' 
dressing room. The kitchen, dining 
rooms, laundry, etc., are shut off from 
the entrance and the office. The ambu- 
lance entrance is close to the elevator and 



staircase. On the second floor are two- 
bed wards, private rooms, central utili- 
ties, and good balconies. The placing 
of parts with relation to each other in so 
small a building is an interesting study. 



276 



THE AMERICAN HOSPITAL 



CHAPTER XIV. 



Perhaps next in importance to the care 
of the patient is the care of the nurse, for 
to do her best and give comfort and help 
to the sick a nurse must conserve her own 
health and strength. When off duty she 
must be able to go out of the environ- 
ment of the sick room, out of the sound 
of suffering, out of the smell of iodiform, 
and in fact out of the hospital atmosphere. 

Any hospital of considerable size should 
have its nurses' residence. This should 
be a separate building, not too remote 
from the hospital, but far enough away 
so that the noises of an entertainment, a 



dancing party or a romp will not disturb 
the patients. 

The more attractive and homelike this 
building can be made and the more allur- 
ing it can be made to the young woman 
who is taking up nursing, the better will 
be the class of women who will come to 
it and, in the end, the better will be the 
care that the patient will receive. 

No matter how small the appropriation 
for a nurses' home, one should plan for 
nothing but single rooms. The nurse's 
work on duty is most exacting, and every 
nurse, whether pupil or graduate, should 




FIG. 329. NURSES' RESIDENCE, HOSPITAL FOR SICK CHILDREN, TORONTO, CANADA. 

GROUND FLOOR. 




OF THE TWENTIETH CENTURY 



277 




FIG. 331. 




FIG. 334. STUDY ROOM, NURSES' RESIDENCE, BRIDGEPORT HOSPITAL, BRIDGEPORT, CONN. 



280 



THE AMERICAN HOSPITAL 




have her own separate room. It need 
not be large, only enough for a single 
bed, closet, dresser, and study desk. 
These can be fitted into an area 8 ft. -6 in. 
by 12 ft.-O in. This is small enough so 
that two beds or cots cannot be put in. 
If a larger room is provided, it means 
that the time will come when the rooms 
will be made to accommodate two nurses, 
and the original idea of privacy will be 
destroyed. The closet should be large 
and, if possible, lighted by a window. 
An adjustable electric drop light can be 
made to serve both for study and toilet 
light. This is the minimum amount of 
light, and of course can be increased to 
any extent. 

The living room should be homelike 
and refined. It should have fireplace, set- 
tle seats, and cozy corners. There should 
be a number of reception rooms where 



the nurses may meet their friends, and 
a sitting or study room on each floor. 

There should be a small tea kitchen 
with gas stove and other conveniences, 
where the nurses may prepare an occa- 
sional "spread" for the refreshments of 
an evening party. 

A large trunk room is necessary, with 
easily accessible racks for trunks. A 
petty laundry, equipped with set tubs 
and ironing boards, should be provided 
in the basement. 

Class rooms for demonstration and 
class work should be planned for in a 
well-lighted section of the building. 
These class rooms should be well equip- 
ped for demonstration in all kind- of 
hospital technique. 

There must be ample toilet facilities 
on each floor — one tub and one water- 
closet for each five or six nurses, one 



OF THE TWENTIETH CENTURY 



281 



6 




FIG. 336. TYPICAL NURSE'S ROOM, NURSES' RESIDENCE, BRIDGEPORT HOSPITAL, 

BRIDGEPORT, CONN. 



wash basin to every four. There should 
be both shower and tub baths. If pos- 
sible, bowls with hot and cold water 
should be placed in every room. There 
should be a slop sink and broom closet on 
each floor. 

Space should be set aside for nurses 
on night duty, preferably in the upper 
story, away from the noise. These rooms 
should be on a separate corridor. 

An infirmary for sick nurses, fitted as a 
hospital unit, should be provided in every 
large home. 

There should be a piazza and balconies 
wherever space and money will permit, 
preferably on the sunny side. If the 
roof be flat, arrangement should be made 
to use it for outdoor sleeping as well as 
for recreation. 

In the larger homes for nurses, it may 
be desirable to provide a separate kit- 
chen and dining-room in the building. In 
small institutions it is more economical to 



place the nurses' dining-room near the 
main hospital kitchen. 

Dr. Donald Mackintosh,* in writing on 
hospital construction, places the nurses' 
residence of Hospital for Sick Children 
( Figs. 329, 330), as the best example of 
convenience, and the plans are reproduced 
here. It is certainly a model home, with 
its great reception hall, dining-rooms and 
kitchen, its swimming pool and gymna- 
sium, its sitting and study rooms, etc. 

The nurses' residence at the Bridge- 
port (Conn.) Hospital (Figs. 331-336), 
planned on the L-shape with provision 
for the future extension completing the 
U-form, is built on the adjoining lot to 
the hospital. 

Reception rooms adjoin the entrance, 
and the social and lecture rooms are con- 
nected. The suite of the superintendent 

■""Construction, Equipment and Management of a 
General Hospital." Published by William Hodge & 
Co., Glasgow. 



OF THE TWENTIETH CENTURY 



283 




284 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



285 




• 2= 3«, 4= O a FLOOR PI.AN\S • 

• LACK F LOOl 36 AIDS 



FIG. 342. 



NURSES' RESIDENCE, OTTAWA CIVIC HOSPITAL, OTTAWA, CANADA. 
Stevens & Lee, Architects. 



286 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



287 




288 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



289 





FIG. 346. NURSES' RESIDENCE, ST. LUKE'S HOSPITAL, JACKSONVILLE, FLORIDA. 



290 



THE AMERICAN HOSPITAL 




FIG. 347. SLEEPING PORCH, NURSES' RESIDENCE, ST. LUKE'S HOSPITAL, 
JACKSONVILLE, FLORIDA. 



of nurses is at the northwest corner, and 
consists of two small rooms and bath. 
There is a study room on each floor. A 
small infirmary of four rooms is provided 
for the care of the sick nurse. The roof 
garden is sufficiently large for all to sleep 
in the open. 

The nurses' residence of the Massachu- 
setts General Hospital, Boston (Figs. 
337-339), is an excellent example of a 
large building. Attention is called to the 
spacious reception room and to the guest 
suite on the first floor. 

The Ottawa Civic Hospital, Ottawa 
( Figs. 340, 341, 342), plans to house 210 
nurses in single rooms. The building has 
six floors. On the ground floor are class 
and demonstration rooms, trunk storage, 
laundry, and tea room. On the first floor 
is a living room thirty by fifty feet in 
size, a reception room, library, and the 
office. On each floor there are sun rooms 
which constitute small sitting rooms, and 
ample balconies. The superintendent's 
suite has its own bath and balcony. Each 



nurse's room has hot and cold water. One 
bath is provided for each seven nurses, 
and a toilet for each six. A special sec- 
tion of the building is set apart for night 
nurses. 

While all hospital buildings should be 
fireproof for the safety of the helpless 
patients, it is sometimes possible to give 
the maximum amount of convenience at 
a minimum cost by making this section 
of the institution non-fireproof. This was 
done in the nurses' residence of the St. 
Luke's Hospital (Figs. 345-347) at Jack- 
sonville. This was built at a very low 
cost, owing to its simple lines, being 
planned on a nine-foot unit system, so that 
all partitions and piping came in vert- 
icals, one above the other. All the nec- 
essary rooms were Drovided for the com- 
fort and pleasure of the nurses, including 
a broad roof balcony for sleeping. The 
outer fini h of this building is the same 
as the others of the group, which are fire- 
proof. 

The plans for the nurses' residence of 



OF THE TWENTIETH CENTURY 



291 




FIRST FLOOR FLAH 

i ' t H=Jfi if 



nuRsn^ home 

IXOMAKD TlORSE ItO^FITAL 

T^ATIClC , "KA55ACHU5P.TT5. 

JS^*/^"* ARCHITECTS 



FIG. 348. 



the Leonard Morse Hospital (Figs. 348, 
349) and of the Augusta (Me.) City 
Hospital (Figs. 350, 351) are here 
shown. 

In the smaller hospitals, a portion of 
the nurses' residence is sometimes set 
apart for the housing of servants. The 
same general conditions should exist for 
servants as for nurses, but some of the 
refinements need not be furnished, al- 
though a separate room for each indi- 
vidual should be provided. Of course, 
where the size of the institution warrants, 
there should be a separate home. 

The same conditions apply to internes' 



quarters. The internes, who are college 
men accustomed to refinement, should 
have comfortable quarters, sufficiently re- 
moved from the patients not to disturb or 
be disturbed. 

One example of help's building on even 
more economical lines is that designed 
for Kings County Hospital (Figs. 352- 
354), New York City, Department of 
Charities. 

This is planned on an eight-foot unit 
basis and has all the necessary common 
rooms, toilets and staircases for a build- 
ing of this nature. 

In the Ottawa Civic Hospital, Ottawa, 





5ECOn D FLOOR PLArl 



FIG. 349. 



AT THE. 

LDDIiARD "MORdE, tlOiflTAL 

NATICK. . MA5bACffUX7TS. 

cowa'ko T £- Y 5T= vcnT" 5 ARCH ITCCT6 



292 



THE AMERICAN HOSPITAL 




FIR.ST FLOOR. PLAN 
P- — i — t — .' - i s 1 

5CALL • OF FE£.T. 



FIG. 350. 



J. Manchester, Haynes HomeForNurses. 

Augusts City Hospital . Augusta . Me. , 

KENDM.L.TAYLOI? &5TEVENS . EDWARD F51CVEN5 



Canada, the third floor of the service 
building is fitted up for twenty-three in- 
ternes. It has a direct connection with 
the main hospital. There is a suite of 
rooms for the superintendent, a library, 
a large living room, two toilet and bath 
rooms, trunk room, etc. 

In the Victoria General Hospital, Hali- 
fax, a similar arrangement is made, four- 



teen internes being housed on the third 
floor of the service building, in comfort- 
able quarters, separate from anyone else. 

In both of these buildings, the house- 
keeper and her assistants are housed on 
the floor below the internes, in special 
suites, disconnected from the working 
part of the building. 




OF THE TWENTIETH CENTURY 



293 




FIG. 352. PROPOSED HELP'S BUILDING. 
Edward F. Stevens, Architect. 




5zmrifc> cT Twifeb TLcor. P>i^s 



FIG. 353. PROPOSED HELP'S BUILDING. 
Edward F. Stevens, Architect. 




FIG. 354. PROPOSED HELP'S BUILDING. 
Edward F. Stevens, Architect. 



294 



THE AMERICAN HOSPITAL 



CHAPTER XV. 



Wje lUtcfjen 

The location and plan of the kitchen 
building, so-called, are most important 
factors in the success or failure of an 
institution. The kitchen, whether an iso- 
lated building or a department in a gen- 
eral building, should be so located that 
food — hot, palatable food — can be readily 
transported, with the least delay and the 
least amount of handling, from the place 
where it is cooked to the patient's tray 
or dining table. To do this, certain con- 
ditions must exist — 

(a) A central location, 

(b) Adequate means of transporting, 

(c) Serving kitchens of sufficient size 

and equipment to care for and 
distribute food properly. 

If occupying only a portion of the 
building, the kitchen should be on the 
ground floor or on the highest floor. 
Many of our best hospital superintend- 
ents contend that the kitchen should be on 
the upper level, while others agree that, 
owing to a greater facility for delivery of 
supplies, the lower basement level is the 
more economical. With a refrigerating 
system and good elevator service, the up- 
per level kitchen has certain advantages, 
the chief being the freedom from odors 
of cooking and the exclusion of trades- 
men from the kitchen. On the other 
hand, the low-level kitchen affords 
quicker delivery of supplies, quicker dis- 
posal of waste products, and, as the 
heavier demand is apt to be on the lower 
floors, quicker service to the greatest 
number of patients. 

The kitchen should not be too large 
or too small. If too large, time is wasted, 
owing to the distance traveled ; if too 
small, it will be too crowded to secure 
the best results. In other words, the 
kitchen should be planned to meet the 
needs of the institution, not forgetting, 
however, its probable growth. 



anb Hatmbrp 



GENERAL PLAN. 

The hospital kitchen should be planned 
like a modern factory — that is, to receive 
the raw material and to deliver the 
finished product (which is palatable 
food) with as few lost motions and 
delays as would be expected by a modern 
manufacturer in his factory. If there 
is any delay by the way, there is a 
loss in food value, and the patient has in 
consequence less of vital energy than with 
efficient service. The same thing applies 
not only to the patient but to the nurse, 
the attendant, the servant, and all along 
down the line. An underfed nurse or 
domestic cannot do her best, so that as a 
purely business proposition it pays to feed 
well everybody connected with the insti- 
tution. 

In the kitchen, the building should be 
planned around the equipment. The 
ranges, which are perhaps the apparatus 
most constantly in use, should be placed 
in the mosr convenient place — generally 
in the center, where all sides are avail- 
able. 

For fuel, circumstances differ, and 
what is best in one part of the country 
may not be good in another. Gas, either 
natural or artincial, in the long run is 
not only the most economical but the 
most efficient. There is no dust, no dirt, 
no unsightly or unsanitary coal scuttle in 
the way. The modern blast burner ranges 
give the same quality of heat as the 
best coal range. Broilers or toasters are 
equally good in ga*. and these should be 
placed on the same line and near the 
range. In the institutions in the west 
crude oil is used both for kitchens and 
for heating boilers. 

With electricity at a minimum cost 
much work can be done with that me- 
dium. 

Much of the cooking formerly done on 
the range can now be more efficiently done 



OF THE TWENTIETH CENTURY 



OF THE TWENTIETH CENTURY 



297 




FIG. 357. TILTING KETTLES. 



by steam. In tne pressure steam cooker 
practically all vegetables can be prepared. 
This cooker should be of sufficient size 
and of propei design to do the work 
easily. 

The steam stock kettles as made and 
used in Europe are much finer in work- 
manship and more attractive than those 
made in America. American manufac- 
turers have begun to make finer, more at- 
tractive, and more hygienic apparatus. 

For the cooking of cereals, the tilting 
kettles are the simplest in action, being 
easily manipulated and cleaned (Fig. 
357). 

All steam apparatus should be planned 
to withstand a pressure of at least sixty 
pounds per square inch. To that end, 
a reducing valve for the kitchen steam 
supply should be provided. 

The kitchen sinks should be planned 
for their special uses — deep sinks for 
pots and pans, and shallow sinks for 
smaller utensils. Vegetable sinks can be 
grouped together. A small sink in the 
cook's table often saves steps. 

The many laDor-saving devices driven 
by the small motor, such as meat chop- 
pers, bread and cake mixers, ice-cream 
freezers and ice crushers, vegetable an 
fruit parers, make the work of preparing 
food vastly easier. Power dish-washers 
save much time and many dishes. Steam 
tables have become a necessity in keeping 
food palatable. 



All cabinets and racks should be open 
and easy to clean. Dish cabinets and dish 
warmers should be at a proper height 
from the floor to prevent extra muscular 
strain in removing the dishes. 

The Cincinnati General Hospital 
kitchen building (Figs. 360, 361, 362 ) 
has the top-lighted kitchen in the center, 
with the diet kitchen at one side and the 
bakery at the other. The dining rooms 
for officers and internes are at one side, 
those for servants at the other, each hav- 
ing its separate entrance. The food ser- 
vice for the hospital is in the center, 
whence the food is sent overground in 
heated cars, to the wards. 

The Ottawa C ivic Hospital, Ottawa, 
Canada (Figs. 78-81). has its service 
building planned so that all its activities 
are concentrated around the kitchen and 
the food delivery. The building is rec- 
tangular, with a skylight above the 
kitchen part, so that it is high, well-lighted 
and well-ventilated. The receiving de- 
partment is at the left in the rear, the re- 
frigerators being along that side of the 
building in their own corridor. At the 
front of the left side (convenient to the 
supplies j are the diet kitchen and the 
dietician's office. In the kitchen itself, 
the scullery or preparation part is at the 
left (near the supply entrance), the cook- 
ing in the center, the bakery at the right, 
d he si earn tables and the space for the 



FIG. 358. KITCHEN DETAIL, STATE HOSPITAL, 
KARLSRUHE, GERMANY. 




298 



THE AMERICAN HOSPITAL 




FIG. 359. KITCHEN, RUDOLPH- VIRCHOW HOSPITAL, BERLIN, GERMANY. 



delivery of food is in the center front, 
whence the food cars are sent through 
the tunnel to lifts at the right and left 
sides of the building. The housekeeper's 
office is at the right ; also the servants' 
dining rooms, which have cafeteria ser- 
vice. 

On the mezzanine floor are storage 
rooms for kitchen supplies, the linen 
stores and the sewing room. On the next 
floor are dining rooms for two hundred 
nurses, the superintendent and the staff, 
with one servery in the center. The 
apartments of the housekeeper, dietician 
and their assistants are on this floor, quite 
separate. The top floor houses twenty- 
three internes. 

In the Victoria General Hospital, Hali- 
fax, N. S., service building (Figs. 363, 
364) food supplies are received at the 
right, the range, cookers and service to 
the wards and dining rooms are in the 
center, and the diet kitchen is at the right, 
near the supplies. There is a cafeteria 
service for the servants on this floor. The 
dining rooms for superintendent, staff 
and nurses are on the second floor, with 
a central servery. 



In the Ohio Valley General Hospital, 
Wheeling, W. Va., the main kitchen (Fig. 
100) is lighted from above and at the 
sides. It is ventilated through a large 
duct extending to the top of the tower 
of the hospital building, so as to elimi- 
nate all kitchen odors from the hospital. 
The stores and refrigerators are at the 
right (other store rooms are on the floor 
below), the scullery and vegetable prepa- 
ration at the rear of the kitchen itself, 
the cooking being done in the center. The 
service of food to hospital food cars and 
to the dining rooms is in the space at the 
left of the plan. The dining rooms are 
grouped around the serving end of the 
kitchen. The nurses' and servants' ser- 
vice is cafeteria. There is a restaurant 
for the friends of patients. 

Attention is called to the kitchens of 
the New Rochelle Hospital, New 
Rochelle, N. Y. (Fig. 381), to that of 
the Wesson Maternitv Hospital, Spring- 
field, Mass. (Fig. 157), and the Good 
Samaritan Hospital, Sandusky, O. (Fig. 
320). ^ These are small units, but the 
principles of planning are the same, that 
supplies shall enter at one side, be pre- 



299 





FIG. 362. FOOD CARS IN KITCHEN, CINCINNATI GENERAL HOSPITAL, CINCINNATI, OHIO. 
Samuel Hannaford & Sons, Architects. 



OF THE TWENTIETH CENTURY 



301 




FIG. 363. FIRST FLOOR, SERVICE BUILDING, VICTORIA GENERAL HOSPITAL, 
HALIFAX, NOVA SCOTIA. 
Stevens & Lee, Architects. 



pared there, cooked in the center, and 
served from the other side. 

Diet Kitchens. Every hospital of con- 
siderable size should have a room for 
the preparation of special diets. This 
room should be near but not a part of 
the kitchen. It must also be near the 
food lifts and the route of service. It is 
customary to use the diet kitchen for a 
teaching kitchen for the nurses in train- 
ing; and where this is the case, cabinets, 
fitted for individual service, are some- 
times provided. 



Attention is called to the diet kitchens 
of the Cincinnati General Hospital (Fig. 
360), the Ottaiva Civic (Fig. 78), the 
Victoria General, Halifax (Fig. 363), the 
Ohio Valley General, Wheeling, W. Va. 
(Fig. 100), and the New Rochelle Hos- 
pital (Fig. 381). 

Serving Kitchens, The serving kitchen 
has a place among the important rooms 
of a hospital, for in this room the trays 
for the food are prepared, and from it 
the food is distributed. If the serving 
kitchen is conveniently arranged, the 




FIG 364 SECOND FLOOR, SERVICE BUILDING, VICTORIA GENERAL HOSPITAL, 
HALIFAX, NOVA SCOTIA. 
Stevens & Lee, Architects. 



302 



THE AMERICAN HOSPITAL 




FIG. 366. KITCHEN, ROSS PAVILION, ROYAL VICTORIA HOSPITAL, MONTREAL, CANADA. 



OF THE TWENTIETH CENTURY 



303 




FIG. 368. SERVING KITCHEN, ROSS PAVILION, ROYAL VICTORIA HOSPITAL, 
MONTREAL, CANADA. 



304 



THE AMERICAN HOSPITAL 



food is more likely to be brought to the 
patient in the best condition. And what a 
difference even the looks of a tray makes 
to a delicate patient ! 

How often one hears it said about a 
hospital, "The operating room technique 
is perfect ; the nursing is all that can be 
desired ; but the food — and the service !" 
Good food, properly served, goes a long 
way toward offsetting deficiencies in 
other departments. 

The serving kitchen should be of suf- 
ficient size to do the work properly. In 
one of the earlier hospitals designed by 
the writer, the planning of which was 
directed largely by the building commit- 
tee, the desire on their part to make every 
inch available for patients made it neces- 
sary for the serving kitchen to be so re- 
duced in size that it has always been a 
great drawback to the best serving of 
meals. A little more space devoted to this 
room would have added greatly to the 
comfort of both nurse and patient. 

What are the essentials and what are 




FIG. 370. SERVING KITCHEN, OHIO VALLEY GENERAL HOSPITAL, WHEELING, W. VA. 




FIG. 369 SERVING KITCHEN, ROSS PAVILION, 
ROYAL VICTORIA HOSPITAL, MONTREAL, 
CANADA. 
Stevens & Lee, Architects. 



the luxuries of a serving kitchen? The 
essentials are : 

1st, Proper Location — Remember that 
a ward serving kitchen is a very busy 
place three times a day. Many utensils 




FIG. 372. SERVING KITCHEN, SHOWING FOOD TRUCK, CINCINNATI 
GENERAL HOSPITAL, CINCINNATI. OHIO. 



306 



THE AMERICAN HOSPITAL 




FIG. 373. AUTOMATIC LIFTS FOR FOOD 
CARS. 

must be handled, washed and put away; 
food trucks are going and coming ; so 
that this room should be located remotely 
or in such a way that the sound from 
the room is cut off from the patients. 
This may be accomplished by having the 
serving kitchen entered from a side cor- 
ridor, as in the Melrose Hospital (Fig. 
304) ; or through a vestibule, as at the 
Royal Victoria (Fig. 115) ; or by having 
it entirely apart, as at the Bridgeport 
Hospital (Fig. 69). 

2nd, Room Enough to Lay Trays — 
There should be room enough, and the 
room should be so planned that no one 
will be crowded while preparing the 
meals. If the building is a multi-story 
building, special food lifts, large enough 
to carry a food car, should be provided, 
and space enough to bring the car into 
the room to discharge it. 

In moving the food from the kitchen 
it should be handled as little as possible. 
To that end, the food truck loaded in the 
kitchen should not be disturbed until it 
reaches the serving kitchen. This food 
truck can be taken on the serving ele- 



vator ; or, better still, special food ele- 
vators may be provided, working auto- 
matically from the sending point on the 
kitchen level. These food trucks can 
be kept warm by electricity, hot water, 
or hot soapstone. The one shown in the 
illustration (Fig. 375) is heated by 
soapstone. 

3rd, Keeping Food Warm or Cold — 
The steam-table is almost indispensable 
for keeping food hot, and should be pro 
vided with a gas plate and warming 
closet. 

Tray racks of sufficient capacity for 
holding all trays should be provided. 
These racks should be mounted on ball- 
bearing casters, so that if required the 
trays can be brought en masse to the 
ward door. The use of the portable hot 
table is growing in popularity (Fig. 376). 
For some classes of patients this makes 
the most satisfactory method of serving. 

Refrigerators should be built or select- 
ed with care and, with due regard for 
hygiene, should be either porcelain or tile 
lined, and should have properly trapped 
drains. If there is a refrigerating plant, 




FIG. 374. OPEN FOOD TRUCK. 



OF THE TWENTIETH CENTURY 



307 




FIG. 375. HEATED FOOD TRUCK. 
Heat is applied by inserting hot soapstones in 
pockets at the sides. 

by all means extend the pipes to these 
small serving-kitchen refrigerators. 

4th, Utensils and Their Cleaning — 
Among the luxuries of the serving 
kitchen might be counted special egg 
boilers, coffee percolators, individual 
services for private patients, special 
china and glass, hot plates and more at- 
tractive trays and linen. 

Where the dishes from patients with 
infectious diseases are cared for, the dish 
sterilizer is absolutely essential. 

The location and size of the sink is im- 
portant. There should be an ample 
drainboard and the sink set high. The 
tendency of the plumber is to place the 
sink at his standard height, making 
everyone who uses it stoop, while placing 
it a few inches higher would save many 
a backache. The material for the sink 
is largely a matter of fancy. Iron, porce- 
lain and soapstone are used. 

A suitable receptacle should be pro- 
vided for the dishes and utensils after 
they are cleaned. The cabinet should be 
hygienic in its construction, easily cleaned, 
with slanting top so that the dust may 
be seen and removed. It should con- 
tain drawers and cupboards enough to 



store the cutlery and silver needed in 
the section served by ward kitchen. 

In General — The room should be tiled 
to a height of four feet. If the expense 
of this is prohibitive, place tiling at least 
back of all plumbing fixtures. 

The floors should be of a non-porous 
substance, like magnesite, terrazzo, or 
tile; if of tile, a gray or buff is much 
easier to care for than white. 

The plan of the serving kitchen of the 
Ross Pavilion of the Royal Victoria Hos- 
pital, Montreal (Fig. 369), illustrates the 
principles laid down above. 

Dining Rooms. The dining-room for 
nurses (if in the same building with the 
kitchen) should be in a well-lighted por- 
tion of the building, and some attention 
should be paid to the decoration and ar- 
tificial illumination. A serving room, 
equipped with steam table and coffee urns, 
should be placed between kitchen and 
dining-room, if possible. 

It has been found in many institutions 
that a dining-room or restaurant for 
friends of the patients is not only a 










; I II 







Kater inan 



3ish warraei 




FOOD CAR. 
For serving patients' direct froa car. 
FIG. 376. PORTABLE STEAM TABLE. 



308 



THE AMERICAN HOSPITAL 



source of satisfaction to the friends but 
also a profit to the hospital. 

The feeding of servants has been ac- 
complished in an economical way in many 
institutions by establishing" a self-serve 
system, where each person selects what 
suits him best, takes it to the table and 



cats. This removes dissatisfaction on the 
part of the servants, facilitates the service, 
and reduces the number of waiters. 

More attention is paid to the design 
and finish of the kitchens in many of 
the larger European hospitals than in this 
country. (Figs. 355, 356, 358, 359). 



THE LAUNDRY 



kike the kitchen, the Laundry and Dis- 
infecting Plant should have an accessible 
location to which the soiled linen and 
articles of disinfecting can be easily 
brought and from which the fresh linen 
can be removed. The size and character 
of the building is, of course, governed 



by the requirements and size of the in- 
stitution. 

In planning the hospital laundry, the 
same care and thought should be used 
as in planning a factory ; that is, to se- 
cure the greatest efficiency in the work, 
from the bringing in of the soiled linen 
to the delivery of the clean. From the 
sorting room to the linen room, an effort 
should be made to avoid lines of crossing 
and re-crossing; one process should fol- 
low the other until the work is completed. 



EI 

TbllET 



-5«EL1= Q 



fc-OOfA 



l&ON 



\:HG 



MA.TTtLE.55 
JTEJULIZEI!. 



JTEHIL1ZINGI 
JlOOM 



I 



0|TuN\6i.Eft. 



•He«JLlZlh|G 

Washed 



xhtiLAdTdfui 



WA-ittE-fc- 



WASHED 



fr-XT Work 

taONE R_ 



Table 




JOILED 

Linen 



Delivery 
ILOOM and 
OFFICE 



men 



Y\^5i Flo oil Plan 

icALt ■ mm m ■ ■ 3 

Jejlvice Building 

M.IDGEPOM" HOJPITAL-^IDGEPOUT CONN 

EbWAfc-D F 6TE.VENS • Afc-CtMTE-CT • &0 3TON MA5^. 

FIG. 377. 




OF THE TWENTIETH CENTURY 



509 




FIG. 379. LAUNDRY, HOSPITAL FOR SICK CHILDREN, TORONTO, CANADA. 



310 



THE AMERICAN HOSPITAL 




FIR..6T FLOOR. PLAhT 



LAVND R. Y • 



FIG. 380. LAUNDRY, OTTAWA CIVIC HOS- 
PITAL, OTTAWA, ONTARIO. 
Stevens & Lee, Architects. 

The washing or wet work should be kept 
separate from the ironing or dry work. 

If, as is quite common now in hos- 
pitals, the soiled linen is bagged at the 
ward unit, then easy transportation 
should be provided for these bags, and a 
covered corridor above or below ground 
is quite desirable for this transporta- 
tion. 

In regard to the equipment of the laun- 
dry, much may be said, but whatever ap- 
paratus is used, the principle which has 
been set forth for the conservation of hu- 
man energy should be brought into play 
in this department. For a single example 
take the sorting bins; if these be placed 
high enough so that it is not necessary 
to stoop every time a single article is han- 
dled and if these sorting bins are made 
with easy-rolling wheels, the transmis- 
sion of the soiled linen will be secured 



with the least amount of fatigue on the 
part of the operators. 

The various items of machinery should 
be selected for the efficiency they will 
show. A washing machine capable of 
doing the work of three ordinary ma- 
chines and costing the price of two is an 
economy. The same is true with refer- 
ence to the extractor, the mangle, the 
drying tumbler, etc. 

Electricity is rapidly taking the place of 
gas and steam in many of the laundry 
operations. The body ironer is being 
superseded by the steam press. 

In a large hospital it is considered de- 
sirable to have the staff linen laundered 
in an entirely different department from 
the hospital linen. 

It is undoubtedly an economy to have 
the main linen room of the institution 
connected directly with the laundry, from 
which the freshly laundered articles as 
well as the new supplies can be given 
out. In this way, the linen, whether new 
or old, is under one supervision. 

A few illustrations will serve to show 
some of the points mentioned. 

In the laundry of the Bridgeport Hos- 
pital (Fig. 377), the writer has attempted 
to work out the principles mentioned ; 
that is, the soiled linen is first taken 
care of in the soiled linen sorting room; 
then carried to the wash room where the 
wet washing work is done ; thence 
through the drying room, mangle and 
linen room, into the main linen supply 
room. Provision for infected clothing, 
which is brought in through a separate 
entrance and introduced into the washing 
department of the laundry through a ster- 
ilizer or sterilizer washer, is here pro- 
vided. 

In the small laundry of the St. Luke's 
Hospital at Jacksonville (Fig. 378), 
where care of both general patients and 
contagious cases is provided, the same 
provision is made for the infected linen — 
passing through a disinfector before 
reaching the laundry proper. 

Fig. 379 shows the interior of the 
laundry of Hospital for Sick Children, 
at Toronto. 

In the service building of the Ottawa 



OF THE TWENTIETH CENTURY 



311 



Civic Hospital, Ottawa, Canada (Fig. 
380) the basement contains the power 
plant for the hospital, the engine room, 
boiler room, fuel store, workshop, etc. 
The first floor is taken up by the laundry. 
The second and third floors house twen- 
ty-eight domestics in single rooms, with 
sitting room, balcony, toilets, baths, 
trunk room, linen room, etc. 

On the laundry floor, the soiled linen 
is brought from the hospital by car or 
truck to the entrance at the left of the 
building ; the trucks come up a ramp di- 
rectly to the sorting room, so that there 
is no lifting. The sorting room is di- 
rectly off the wash room. Infected linen 
goes to a special entrance at the rear, is 
put into the disinfector there, and taken 
out from the laundry side. To the right 
of the wash room is the ironing room. 



with a drying tumbler for blankets, pil- 
lows, etc., and a dry room at the rear. 
The flat-work ironer is in the center. 
The hand ironing boards and special iron- 
ers are near the windows. There is plen- 
ty of table space. The clean linen sort- 
ing room, with tables, shelves and boxes, 
is at the front, near the entrance. 

The service building of the New Ro- 
chelle Hospital, New Rochelle, N. Y. 
(Fig. 381), takes care of a hospital of 
75 to 100 beds. There is a fair-sized 
kitchen, and three dining rooms which are 
served directly from the kitchen. In the 
laundry there are sorting bins for soiled 
linen, near the washer, tubs for hand 
work, soap and starch kettles, a drying 
room, and space for hand and machine 
ironing. There is a good sorting room 
for clean linen. 




FIG. 381. SERVICE BUILDING, NEW ROCHELLE HOSPITAL, NEW ROCHELLE, N. V. 
Edward F. Stevens, Architect. 



312 



THE AMERICAN HOSPITAL 



CHAPTER XVI. 

^eating, Ventilating anb ^lumtjing 



The power plant, the center of the me- 
chanical end of the hospital, in many 
respects is not unlike the power plant 
for any institution or manufactory. A 
hospital plant, however, is unique in its 
demand for the production of steam in 
an economical way, the transmission of 
the steam into horsepower energy, 
either for generating electricity, furnish- 
ing high pressure steam for laundry, 
kitchen, or sterilizing room, inasmuch as 
steam — i. e. high pressure steam or its 
equivalent — is needed twenty- four hours 
a day and three hundred and sixty-five 
days in the year for sterilizing. There- 
fore there is little saving made, even in 
a small plant, by using low pressure 
heating and using gas or electricity for 
sterilizing. 

Using steam for sterilizing, cooking, 
and laundry, it can be readily seen that 
the generating of electricity would show 
a marked economy, even in the small in- 
stitution, for in the heating months the 
exhaust steam from the engines would 
serve for heating the buildings, reducing 
the cost of current and heating to a 
minimum. It is not intended, however, 
in this book to discuss the power plant 
methods, but merely the portions of the 
plant affecting the health and comfort 
of the patient. 

The much discussed problem of how 
properly to heat and ventilate a hospital 
building has still many unsettled points, 
almost as many as the floor problem. It 
is still undecided whether it is best to 
conduct the air to the ground floor or 
basement, heat it there, send it through 
the building warmed, washed and humid- 
ified, and force it into the closed room 
under thermostatic control at a given 
temperature night and day, a system 
which necessitates for its perfect work- 
ing the closing of all doors and windows ; 
or whether to heat the air by means of 
indirect radiators in the basement or pipe 



space and conduct it by its own ascentive 
force to the rooms or wards ; or whether 
to use the simple system of putting the 
heating units in the room and introduc- 
ing outside air directly below or above 
the radiators ; or whether by direct hot 
water, direct steam, or a combination of 
various systems. 

One of the simplest methods and one 
adopted by the writer for securing fresh 
warmed air is a modification of the com- 
mercial direct-indirect radiator. (Fig. 
382). A radiator (hospital type pre- 
ferred) is set on brackets four inches 
above the floor ; air is introduced through 
the outside wall directly in line with the 
bottom of the radiator. A shield, hinged 
at the bottom to allow for cleaning and 
extending under the radiator joining the 
intake pipe, prevents direct cold air from 
entering the room; and a damper in the 
direct flue governs the amount of air. At 
the new General Hospital at Vienna, out- 
door air is introduced directly above the 
radiator, as shown in Fig. 383. 

Many medical men and hospital ex- 
perts agree that the patient in bed, ex- 
cept in special cases, should not have a 
high temperature in his room. They 
agree that Nature calls for changes in 
temperature — that the man in robust 
health demands them ; that the patient 
who is building up his strength should 
not be denied them. A certain professor 
in a technical school used to say to his 
class that the ideal temperature is that 
of a sunny June day in a New England 
pine forest. Such an idea does not in- 
volve an even temperature of sixty-eight 
degrees for the entire day. 

Manufacturers of various apparatuses 
pride themselves on controlling the tem- 
perature of a room to a fraction of a 
degree, as shown by chart record (Fig. 
384). This would not seem to be con- 
ducive to the best results, excepting under 
certain conditions. 



OF THE TWENTIETH CENTURY 



313 



The breathed air in a ward or room 
should be in some way removed, and 
the means for ventilating so located as 
to insure a complete circulation of air. 
If the room is large, there should be 
vents at top and bottom, with dampers, 
so that the air can be drawn from either 
one or the other, by properly adjusting 
the damper. 

The vent ducts should start at the 
floor, and the floor material extended 
to the back of the flue (Fig. 385), or 
the bottom of the flue curved so that no 
dust shall remain in it. In no case 
should a register face be used to close 
the opening at the floor. 

However the air is introduced, the ex- 
haust should be placed so as to vent all 
parts of the room. If the air is intro- 
duced at or near the window, the ex- 
haust should be near the door. The de- 
sirability of ventilating the clothes cup- 
boards as well as the room led the writer 
to adopt the method of placing the room 
vent in the ceiling of the cupboard, cut- 
ting the door thereto so as to leave an 




Method 



* Heating general Ho/pital 
At Vienna 



FIG. 383. 



open space below, setting the cupboard 
shelf away from the wall, and in this 
way allowing a free circulation of air, 
ventilating the room and cupboard. (Figf. 
387.) V * 

Tbe natural "tepee" form of ventila- 



Copper wire 
Screen 

FACE ^ 



'ftrcsh & f< duct 

Hdam.hr' 

9 t 




Radiator Shield 

^-Plah Loontnc down 



FIG. 



382. DIRECT-INDIRECT RADIATOR, SHOWING REMOVABLE SHIELD. 



314 



THE AMERICAN HOSPITAL 




FIG. 384. HEATING CHART, SHOWING UNDE- 
SIRABLE CONDITION FOR SICK ROOM. 

tion is used in a number of Massachu- 
setts institutions — that is, providing for 
heat units on the outer walls, either ra- 
diators or coils ; making the side walls 
low, about seven feet, and sloping the 
ceiling at least thirty degrees to a moni- 
tor vent. The result is ideal heating 
and ventilation, but the difficulty of using 
this method in large units is the neces- 
sary waste space involved in the sloping 
ceiling and the monitor, although this 



;jL; 




FIG. 385. DETAIL OF VENT FLUE AT FLOOR. 



has been carried out in the Children's 
Hospital in Boston, in the State Hos- 
pital School for Crippled Children at 
Canton, Mass. (Fig. 388), and in the 
children's ward of the Worcester City 
Hospital (Fig. 184). 

The use of hot water for general heat- 
ing and steam for special ventilating 
units gives satisfactory results. The hot 
water may be in coils of large pipes, eas- 
ily cleaned, or radiators of hospital type 
set away from the wall ; but the common 
ornamental radiator, set close to the wall, 
should never be used in the sick room, 
since every surface should be available 
to the brush or vacuum cleaning pipe. 




FIG. 386. DETAIL OF VENT FLUE ABOVE FLOOR. 

No institution is so economical to heat 
as is a hospital, because it can be done 
by utilizing exhaust steam from the en- 
gines which produce power for the elec- 
tric light, laundry, and refrigeration. A 
very small part of the heat units are 
removed in passing through the engine. 
The method is therefore a decided econ- 
omy in the production of power and in 
the heating of the building. 

The heating of the operating room at 
St. Georg's in Hamburg is one of the 
more elaborate systems. In the section 
shown (Fig. 121), it will be observed 
that the outer sash is double and the air 
conducted entirely around this hollow 
space, warming in winter and cooling in 
summer the floor, the walls, and the ceil- 
ings. In winter, additional heat is se- 
cured from direct radiators behind thin 



OF THE TWENTIETH CENTURY 



315 



nickel plates shown in the walls, but al- 
lowing no air from this source to enter 
the room. The air for the operating 
rooms is brought first into a clean cham- 
ber where it is passed through ground 
coke, thence over heated coils in winter 
and over ice in summer, into the fan, 
where it is driven through a filter ot fine 
sand and gravel, and taken thence to the 
operating rooms, practically free from 
all bacteria. The ceiling vents in the 
operating rooms are closed and there is 




FIG. 387. DETAIL OF VENT THROUGH CLOSET. 

sufficient pressure outward so that the 
opening of a door does not admit any 
foul air. 

A simpler method for the heating and 
supplying of fresh air for the operating 
room is by the use of a screen or false 
wall inside the operating window. The 
heating unit is placed between the screen 
and the outer window, introducing out- 
door air at the top (not the bottom) of 
the radiator. The air from the room 
drawn under the screen mingles with 
the outdoor air, is heated, and passes 
out over the top of the screen, warmi:-^ 



the room by this inflow and by direct 
radiation from the glass screen. Ad- 
ditional radiating surface may be placed 
above the ceiling lights. To prevent the 
entrance of any dust from outside, gauze 
removable screens may be placed in the 
openings at the top of the screen. A sec- 
tion through the operating rooms of the 
Ross Pavilion of the Royal Victoria 
Hospital (Fig. 389) will serve to show 
this method, and a reference to the illus- 
tration of operating rooms at the Bridge- 
port Hospital (Fig. 134) will show the 
effect from the room. 

Additional radiation may be secured 
by radiators entirely concealed in wall 
pockets whose openings are covered with 
metal plates or marble slabs. Fully fifty 
per cent, of the radiation is lost in this 
process, though the radiator is hidden 
effectually and hygienically. 

It is desirable to use forced ventila- 
tion in the operating suite, if nowhere 
else. If the suite is small, the fan may 
be placed nearby and operated when the 
rooms are in use. Gravity ventilation, 
however, should be provided, with a by- 
pass valve so connected with the switch 
and fan that when the fan is stopped 
the damper automatically opens to the 
gravity vent, which itself should be ac- 
celerated by a steam coil. 

No attempt is made here to furnish 
data for the power plant or the heating 
and ventilation of the hospital, for these 
should be worked out with the heating 
specialist ; but these few suggestions are 
offered as the results of the observation 
of the writer in his own practice. 

Hospital plumbing, so far as the pipes, 
drains and vents, and the so-called 
"roughing-in" are concerned, is no dif- 
ferent from that for any other building 
of like grade ; but the actual fixtures 
should be selected or designed for the 
purpose for which they are to be used. 
Hospital plumbing should be standard- 
ized as far as possible. 

Where practicable, fixtures should 
stand clear of the walls to facilitate 
cleaning and to prevent vermin from 
finding a lodging, and the wall immedi- 
ately behind the fixture should be pro- 
tected with tile placed flush with the ad- 



316 



THE AMERICAN HOSPITAL 



joining plaster. If this is done, the ill 
effect of spattering will not be seri- 
ous. 

The plumbing trap, in our modern 
times, is the one necessity of every 
plumbing fixture which has the recep- 
tion and discharge of liquids into the 
drainage system. It can readily be seen, 
if the hygienic condition of our fixtures 
be considered, that this trap should have 



two possibilities — 

(a) To safeguard properly the es- 

cape of sewer gas or sewer 
odor into tbe room ; 

(b) To be so constructed that tbe 

inside as well as the outside, 
or at least the inside to the 
water line, shall be accessible 
for frequent cleaning. 
To do this latter readily, the trap must 




FIG. 388. HOSPITAL SCHOOL AT CANTON, MASS. SHOWING ROOF VENTILATION. 



OF THE TWENTIETH CENTURY 



317 




*LA/I Of OKMTMQ- lOO/A A.QT\oA TttG.0' OfLUmq U.o/i Lm'AA" 

R.o/y ^avilio/J - HoVa-l Victoria- Ho/^ital 

FIG. 389. 



be set close to the fixture, and have a re- 
movable strainer for cleaning. Few 
medical institutions, even, have traps 
accessible in this way. And still how 
important this feature is ! Of course 
every trap should be vented or have 




FIG. 390. SURGEONS' SCRUB-UP IN OPERATING 
SECTION, QUINCY CITY HOSPITAL, 
QUINCY, MASS. 



some anti-syphon device, but the local 
plumbing law generally governs this 
feature. 

Overflows constitute another filthy, 
unhygienic condition that exists in nine 
<nit of every ten bowls, sinks, or bath- 
tubs in general use. These are general- 
ly built integral with the china or iron, 
never smooth at best, and rarely get-at- 
able in any way. The construction of 
all bowls and sinks should be simplified 
by the use of the celluloid standpipe, 
which is light and easily cleaned ; or the 
full, open overflow, with strainer, or 
similar device. In the double sink, if 
the partition is a little lower than the 
sides, one sink serves as an overflow for 
the other. 

The washing in running water, re- 
quired by certain religious sects, is really 
the ideal of cleanliness. 

The piping requiring polishing should 
be reduced to a minimum, for the care 
of brass work is a considerable item of 
expense in a large institution. Where 
polished brass is desired, yellow metal 
should be specified. Heavily nickel- 
plated pipes and fixtures wear well. 
Pipes and fittings finished in white 
enamel, properly applied, are very satis- 
factory. The traps and less conspicuous 



THE AMERICAN HOSPITAL 



318 




FIG. 391. SLOP SINK, WITH FOOT PEDAL FOR 
FLUSHING. 



parts may be bronzed or painted, saving 
considerable expense. 

The new type watercloset, hung from 
the wall (where the construction will 
permit), is a great improvement over 
the old styles, and is being used in many 
institutions. The material selected for 
seat is important ; if covered with cellu- 
loid or some other acid-resisting sub- 
stance and cut away in front, it is much 
more hygienic. The cover, as a rule, 
should be omitted. The flushing can be 
accomplished either by a flushing valve, 
low-down or high tank so long as it 
works properly. The water seal, quiet 
action, and appearance are all questions 
to be considered. 

The slop sink in the work room is 
used largely for the emptying and cleans- 
ing of bed pans and urinals, and the fix- 
ture should be so planned that this can 
be accomplished quickly and easily. To 
do this, the hopper must have a large, 
unobstructed outlet like that of the 
watercloset ; it should slope quickly to 
the outlet ; means of cleansing the in- 
side must be provided, either by a flush- 
ing rim or a short piece of flexible 
hose, or both, the hose being the sim- 
plest method of cleansing the inside of 
the utensils. The fixture should be set 




FIG. 392. BATH IN ADMITTING ROOM. ISOLATION BUILDING, ST. LUKE'S HOSPITAL, 

JACKSONVILLE, FLA. 



OF THE TWENTIETH CENTURY 



319 




FIG. 393. BABY BATH. 

high enough so that the work can be done 
without stooping. If a sterilizing hop- 
per is wanted, secure one in which 
all the contents can be sterilized, and 
one which can be easily cleaned and re- 
paired. 

Many of the so-called "clinic" hop- 
pers are simply a complicated mass of 
valves, pedals and sprays, which need a 
mechanician to operate and keep in or- 
der. The simpler the fixture (Fig. 391), 
the more effectual it is. 

Fig. 391 shows a siphonic action hop- 
per, which retains a large body of water 
in the bottom, so as to give a thorough 
flushing. It has a flushing rim, actuated 
by a pedal. 

Bath tubs for patients should be set 
up from the floor for two reasons — 
facility of cleaning underneath, and ease 
in bathing if nurse or attendant needs to 
assist. The inlets should be large, allow- 
ing the full discharge of hot and cold 
water at the same time. The type of 
inlet used on ocean steamships allows 
of quick filling. The overflow, if any, 
should be easily cleaned ; but in most 



cases, there is no need of an overflow. 
A plug or standpipe and not a "flow- 
back" form of concealed standpipe should 
be used. The celluloid standpipe, which 
is light and easily cleaned, is less likely 
to cause damage if dropped. 

It is the opinion of many hospital ad- 
ministrators that the only way to be sure 
that a patient is thoroughly bathed is to 
use some form of shower bath. This 
may be a shallow tub or bathing slab, set 
high but within easy reach of the attend- 
ant, the patient being washed in clean, 
running water by means of a hose and 
spray, the tub or slab becoming merely 
a drain for the water. In this way all 
of the dirt goes directly to the drain 
and is not diluted and used again on the 
body. This form of bath (Fig. 392) 
should be used with entering patients, 
particularly in the contagious and chil- 
dren's departments. In many of the 
European hospitals for women this form 





FIG. 393A. DETAIL OF BABY BATH. 
A — Hot water compartment for heating slab. 
B — Hot water swing joint to fill compartment A. 
C — Flexible hose with self-closing spray. 
D — 40-gallon storage tank, with thermometer 

and gauge glass. 



320 



THE AMERICAN HOSPITAL 



is the only one used. The same principle 
serves in the portable tub (Fig. 203) de- 
scribed in Chapter IV. Provision must 
be made in the plumbing, however, where 
this form is used, for a suitable floor 
drain and a hose connection to the room 
hxture. 

The principle of the high, shallow tub 
or slab is quite generally used in bathing 
children (Fig. 393) and infants. In both 
cases some reliable temperature-control- 
ling device should be placed on the sup- 
ply or a separate storage tank placed di- 
rectly above the bathing slab. This tank 
should have a visible thermometer and 
water gauge. The use of the spray can 
be facilitated where there is a storage 
tank by using a self-closing spray head. 

Jdie infants' bath is naturally smaller 
than the children's, and the slab may be 
heated by admitting hot water to the 
closed space in the porcelain directly un- 
der the slab. 




Courtesy "The Trained Nurse." 
FIG. 394. DIAGRAM SHOWING CONSTRUCTION 
OF LAVATORY. 




FIG. 395. LAVATORY FOR WARDS AND PRIVATE 
ROOMS, WITH WRIST VALVES. 

The Wash bowl or lavatory now placed 
without restraint in the patients' rooms 
and the open corridor, as well as in the 
toilets and wash rooms, should be de- 
signed on the same simple lines suggested 




FIG. 396. TYPICAL LAVATORY FOR PATIENT'S 
ROOM. 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



323 




FIG. 399. A PAGE FROM A SWISS PLUMBING CATALOGUE. 



for other fixtures. The non-concealed 
overflow, the removable strainer, and 
the high trap, all are desirable features ; 




FIG. 400. SURGEONS' SCRUB-UP, OHIO VALLEY 
GENERAL HOSPITAL, WHEELING, W. VA. 



in fact, in nine cases out of ten the stop- 
per can be eliminated if a combination 
faucet is used ; for, once accustomed to- 
washing under running water, the filled 
bowl and washing in dirty water will 
be abandoned. 

For ward bowls, bowls in corridor,, 
and bowls for scrubbing up for dress- 
ings, the wrist or elbow mixing- valve 
may be used to advantage (Figs. 395, 
396). 

Where it is desirable to fill the bowl, 
a standpipe of celluloid, made to fit the 
opening, gives an easily cleaned overflow. 

Fig. 394 shows the construction of 
such a lavatory. 

Fig. 395 shows a simple, inexpensive 
lavatory, with a combination faucet hav- 
ing quick-movement valves, and an el- 
bow or wrist handle. The trap is close 
up, the overflow not concealed. This is 
adapted for general use, or for scrub-up 
purposes. Another good lavatory is 
shown in Fig. 396. 



324 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



325 




FIG. 405. MARBLE AUTOPSY TABLE, WITH SINK ATTACHED. 



Figs. 397 and 398 show several simple 
plumbing devices which were planned to 
be used in the United States overseas 
army hospitals. Special attention is called 
to the continuous-flow bath tub (X 31) 
and to the simple combination faucet 
X 15. 

The scrub-up for the surgeon, as a 
preparation for operation, has under- 
gone various changes : from the foot 
valve, good at times but depending on an 
even-pressure of the foot of the surgeon 
to produce an even flow of an even tem- 
perature; then various forms of the knee 
valve, dependent upon a mixing valve 
for the temperature, without regulation 
of flow ; up to the simpler elbow or fore- 
arm control. Again we find that the 
work of the European specialists has 
given us models from which to work. 
A page from a Swiss plumbing catalogue 
(Fig. 399) shows a variety of simple 
forms of both foot and elbow action 
valves. For the scrub-up for a number of 
surgeons, the long sink with several sets 



of outlets has proved satisfactory. Single 
bowls, set together on one central screen, 
as at the Ohio Valley General Hospital 
(Fig. 400) or the Youngstown Hospital, 
allows of easy access. In the smaller 
hospital this same idea may be carried 
out with a raised basin in the center of 
the operating rotunda, as at the Charles 
Choate Memorial Hospital (Fig. 401); 
for, with the combination non-hand- 
touching valve, all that is needed is suffi- 
cient spillway for the water. This form 
of scrub-up valve placed over the work- 
room sink gives an additional place for 
washing. It may be placed over a simpler 
sink in infectious wards, allowing for the 
special cleansing of the nurse's hands and 
the giving of the baths in the portable 
tubs (Fig. 402). (See Chapter VII.) 

The floor drain, highly important in 
certain sections, may be a menace to 
health unless properly constructed and 
kept filled with water. For operating 
and autopsy rooms a flushing rim trap 
is desirable. This top should be solid, 



326 



THE AMERICAN HOSPITAL 



to resist the movement of heavy fur- 
niture (Fig. 403). 

The autopsy table is generally made a 
part of the plumbing, and a simple fix- 
ture which has proved satisfactory is 
shown herewith (Figs. 404 and 405). 
The center is the highest part, allowing 
the fluids to flow away from rather than 
toward it. A small sink, made integral, 
is provided. A simple means of flush- 
ing is obtained by using a flexible hose 
pipe, into which a copper wire is in- 
serted. By means of this the end of 
the hose may be made to remain in what- 
ever position it is placed, allowing the 
flushing action to go on without inter- 
ruption. 



The drinking water problem of the 
hospital has been solved in various ways 
by various hospital men. There should 
be a goodly supply of pure water easily 
procurable for the patient, for the nurse, 
for everybody. 

The system used by the writer at the 
Ohio Valley General Hospital and at the 
Royal Victoria Hospital is to distill all 
the water for drinking and clinical pur- 
poses. 

On each floor outlets were provided 
where the water is cooled, installing a 
fountain for patients' use (Fig. 406). 

This fountain is provided with an out- 
let for drawing water into a receptacle 
as well. 





FIG. 406. "BUBBLING" DRINKING FOUNTAIN, 
FOR HOSPITAL CORRIDORS. 



OF THE TWENTIETH CENTURY 



327 



Betatte of Construction anb Jf tnisifj 

CHAPTER XVII. 



The exterior details of the hospital 
should be made to conform to the style 
of architecture in which the building is 
designed and should be left to the archi- 
tect, it being borne in mind that the detail 
and exterior treatment should be subser- 
vient to the plan ; in other words, the ex- 
terior should be designed around the plan, 
and not the plan made to suit the eleva- 
tion as is so often the case. Economy 
in construction can be realized by es- 
tablishing units in the planning, by hav- 
ing the partitions continuous and the 
plumbing of one story near that of the 
others. 

The interior finish, especially in the 
patients' rooms, should be carefully 
studied from the economic and hygienic 
sides. Projecting surfaces are difficult 
to keep clean and should be eliminated 
as far as possible. If the door jambs 
are made of steel pressed to a suitable 
form, with angles rounded, and are set 
to form a ground for the plasterer, there 
will be no projection. To avoid the usual 
sharp angle at the junction of the door 
jamb and the floor, the door stop should 
be omitted for a few inches above the 
floor and the coved base allowed to run 
through the jamb (Fig. 407). If the 
door jamb is of wood, the same general 
detail can be used ; and to protect against 
the slight sinkage of plaster, a small oval 
wood or metal strip can be used (Fig. 
407A). Transoms, where used, may be 
the thickness of the door, and the usual 
projection avoided. 

Fig. 408 shows the detail of a door 
frame in a thin (two-inch) solid parti- 
tion. It can be used to advantage in 
separation between rooms, or in store- 
room partitions. 

The base around the rooms can be 
made of the floor material or of tile, 
marble, metal, wood, or any enduring- 
material, depending on the appropriation 
and the individual preference; but if 
coved at the juncture of wall with floor, 



made flush with the wall line, and carried 
through the door jamb of the same ma- 
terial, the hygienic qualities are en- 
hanced. To prevent the furniture from 
marring the walls, a furniture shoe 
formed in the base, three or four inches 
from the wall, can be used to advantage. 
Bases and door jambs of this type are set 
before plastering, so that every part of 
the finish is smooth with the wall. 

Windows should be placed low enough 
so that a patient in bed can readily see 
out upon the street. The same character 
of finish should be applied to windows 
as to doors. It has been found that the 
direct draft from a slightly opened 
window may be diverted if a deflector 
is placed in front of the opening. This 
can be formed in the window frame and 
so become permanent ( Fig. 409 ) . 

The "full-view" casement window 
shown in Figs. 410 and 410A is particu- 
larly adapted for solaria and for airing 
balconies which it is desired to close oc- 
casionally. This method of hanging per- 
mits the sash to be opened about 80 per 
cent, of the whole, giving practically the 
effect of a wide-open balcony. The 
sashes opening out simplifies the screen- 
ing problem, since it may be accomplished 
with sliding screens. 

Fig. 411 shows a window of which the 
special advantage is that it has a hinged 
sash swinging in, with a cheek piece at 
either side, so that the incoming air is 
deflected toward the ceiling. This win- 
dow was originally designed for war hos- 
pitals, but is equally adapted to perma- 
nent structures. It is suited to any sort 
of ward or room, and is excellent for 
crowded wards where it is difficult to se- 
cure ventilation without drafts. 

Its disadvantage is the difficulty of get- 
ting at outside blinds or screens ; but by 
placing a small sash at the bottom, as in 
cut, access is gained to outside blinds, 
awning adjusters or screens ; this may 
also become a bottom ventilator. 



328 



THE AMERICAN HOSPITAL 



The hardware required for it is of the 
simplest sort ; two friction hinges, and a 
snap catch on each section, and at the side 
a chain to keep the sash from going be- 
yond the horizontal, with a screw hook 
to catch a link of the chain if one wishes 
to drop it only part way. 

All angles, whether wall, floor or 
ceiling, should be coved. 

Doors should be smooth, without 
moulding. The no-panel slab doors are 
desirable ; or if these prove too expen- 
sive, the one panel, or at most two-panel, 
door can be used. All doors of wards, 
patients' rooms and balconies should be 



wide enough to permit the passage of a 
bed. 

Fig. 412 shows the construction of a 
pivot door which may be used to close 
alternately two adjoining doors. Its 
special use is in intercommunicating 
baths between two private rooms, as in 
Fig. 58. 

Walls back of all plumbing fixtures 
should be tiled, with the tile on the same 
surface and even with the plaster. The 
walls of toilets, sink rooms, serving kitch- 
ens, laboratories, and similar rooms 
subject to much use, should if possible 
be tiled to a height of five feet or more. 




FIG. 407. 



OF THE TWENTIETH CENTURY 



329 



DODJL 



vm^ cut 

FOR. VENTILATJi 




< 



JROM_[LOOR. 

whew: jcHola 



: 

FILMfeCUT 

m}m WITH WfliL LATH 
I i 
I I 



IniMtt EXTINW 

fTO HOUGH FL0 D8- | 

FIG. 407A. WOOD DOOR JAMB 



Medicine closets for each unit (Fig. 

413) , built into the wall, should have no 
re-entering angle. They should have a 
small sink, with hot and cold water, and 
slab, with tiling at the back, shelves of 
plate glass or metal, artificial lights, 
towel rack, etc. If the unit is small, a 
built-in medicine closet at or near the 
corridor bowl can be substituted (Fig. 

414) . 

The clothes closets for private rooms 
or wards (Fig. 387) should be built like 
the medicine closets. If the closet door 
is cut two inches short at the bottom, the 
vent for the room may be placed in the 
closet ceiling, and the ventilation of both 
room and closet accomplished. (See 
chapter XVI on heating and ventilating. ) 

Fixed equipments such as linen closets, 



kitchen cabinets, etc., should be con- 
structed so as to leave a free space be- 
hind them. The linen closets should have 
open shelves or racks, so built that they 
are removable for cleaning (Fig. 415) ; 
if the top is sloped, the minimum amount 
of dust is accumulated (Fig. 416). 

Fig. 417 shows a booth designed for 
the giving of nasal and throat treatments 
in the out-patient department. Its size is 
but 3 feet 8 inches by 4 feet 6 inches. The 
screen partition is of metal, enamelled, 
the table top of the same material. There 
is an electric instrument sterilizer, an ad- 
justable lamp, a special small bowl with 
running water, a rack for bottles, an 
extra shelf for supplies, etc. 

Hardware is a small but very impor- 
tant item, and should be carefully select- 
ed with an eye to its suitability for hos- 
pital purposes. Unsuitable, noisy hard- 




FIG. 



METAL DOOR JAMB FOR 2-INCH 
SOLID PARTITION. 



330 



THE AMERICAN HOSPITAL 



ware has been the cause of more dis- 
turbance to patients in an institution than 
almost any other item in the construc- 
tion. How often one sees the latches 
"muzzled" with a towel or special pad 
which slips around the knobs, or covered 
weights placed behind the door to pre- 
vent slamming! Hardware suitable for 
a dwelling, an office building, or a the- 
atre is not suitable for a hospital. 

How often the nurse, with both hands 
full, is annoyed and delayed in opening 
the door with the round knob ! And how 
often the closing of the same door 
awakens or annoys the patient ! 

Door knobs are also a definite source 
of infection. They are particularly 
dangerous where cases of communicable 
disease are cared for. 



The opening of the door with both 
hands full can be accomplished with the 
angle door handle, and this is a good 
device where noise does not enter into 
the problem, as in service buildings ; 
however, in psychopathic wards the 
handle should have no shank and should 
be turned down instead of up. 

With an efficient checking spring and 
noiseless door holder, the latch bolt can 
be eliminated, and with it much of the 
noise from hardware ; then, with the 
reversed hook handle (Fig. 418) placed 
on the inside of the door, one can open 
the door, with both hands filled, by 
slipping the forearm under the hook 
handle ; and of course, with the latch 
eliminated, the door can be readily 
pushed open from the outside. For the 




FIG. 409. 



OF THE TWENTIETH CENTURY 



331 



occasional locking of the door, a dead 
bolt can be installed. 

The hardware for the elevator doors 
should always run smoothly and afford 
protection against opening of doors when 
car is away from landing, but the silent 
feature should be emphasized in select- 
ing this hardware. 

With reference to floors, the persist- 
ent question "What is the best floor" 
is hard to answer. Among the leading 
architects and hospital men in Europe, 
the writer found the almost universal 
preference to be for tile, usually a light 
gray flint or vitreous tile, as large as 
four inches, laid with a fine joint and 
against a coved base of the same ma- 
terial. In America, with every avail- 
able material and numerous advocates 
of each, it becomes almost a case of in- 
dividual preference. There are certain 



underlying principles, however, which 
should be considered : 

(a) Fitness for location. 

(b) Durability. 

(c) Artistic effect. 

The patients' room should have some 
resilient material, quiet in color and 
reasonably non-absorbent ; resiliency and 
durability should be considered for the 
corridor ; and durability and non-absorb- 
ent qualities for the utilities. 

Good results may be obtained with 
hardwood floors and perhaps they are as 
popular today as any other floor. With 
the fireproof buildings, however, the de- 
mand is for a floor of fireproof material. 

Of the monolithic floors, terrazzo 
gives perhaps as good results as any sim- 
ple, inexpensive floor ; two colors may 
be used, one for the base and border and 
one for the field, with a dividing line 




FIG. 410. FULL VIEW WINDOW 



332 



THE AMERICAN HOSPITAL 




FIG. 410A. FULL VIEW WINDOW DETAIL. 



between of single marble tessarae. Some 
of the magnesite floors are giving good 
results, when properly laid. This can be 
put down in contrasting colors and the 
artistic effect is pleasing. Under cer- 
tain conditions — for example, when laid 
in kitchens and toilets, where very hot 
water may be spilled — this material is 
apt to disintegrate and to spot badly. 

Quarry tile makes a good wearing 
floor in the service part of the hospital 
and for roof wards and airing balconies, 
and is artistic as well. 

Where strict economy must be prac- 
ticed, a good quality of cement floor, 
properly treated to prevent dusting, 
serves its purpose well. 



All the asphalt floors should be avoid- 
ed excepting for special places like por- 
tions of laboratories, refrigerators, etc., 
where an acid-proof floor is required. 

Hard, fine-grained marble makes a 
most excellent operating room floor. 
Opalescent glass has been used more or 
less successfully for the same purpose. 

For corridor floors, where there is 
much traffic, probably the best material 
is pressed cork tile. This is quiet, re- 
silient, and wears well. Cork tiling and 
rubber tiling have been used in toilets 
and baths, but they possess little ad- 
vantage over terrazzo or magnesite. 

For wards and private rooms, wood 
floors are cheap and look well, but are 
open to many objections. They shrink 
and swell, have many cracks to gather 
dust, and need constant refinishing. 
Maple is undoubtedly the best wood floor 
material for a hospital. 

Almost everywhere in Europe lino- 
leum is used for the floors of patients' 
rooms and wards, and its use is growing 
in favor in this country. It can be used 
not only for floors, but for stair treads, 
table tops, screens, and even for door 
panels. When properly laid, it is doubt- 
less the most satisfactory material which 
can be found. Great care must be taken 
to have the floor underneath smooth and 
dry, and the material must be thoroughly 
stretched and laid upon the floor for sev- 
eral days before being fastened down, 
then cemented to the construction, the 
cement being applied to the entire under 
surface. If the newer colors and pat- 
terns of linoleum are used, the effect is 
very pleasing. 

Too much care cannot be taken in the 
planning and arrangement of artificial 
illumination, especially for the rooms oc- 
cupied by patients. The eye, at all times 
a delicate organ, becomes more sensitive 
in sickness. Beds should be so placed as 
to shield the patients' eyes in the day- 
time, which means that they should not 
face the windows. In open wards, this, 
is avoided by the use of cross screens, as 
shown in the Bridgeport Hospital (Fig. 
69) and in St. Luke's Hospital (Fig. 
152). For night lighting, direct ceiling 
lights should be avoided ; instead, re- 




FIG. 411. DETAIL OF WINDOW USED IN ARMY HOSPITALS. 
Charles Butler, Architect. 



334 



THE AMERICAN HOSPITAL 




FIG. 412. 
FROM 



PIVOT DOOR SEPARATING BATH 
TOILETS IN PRIVATE SUITE 



Edward F. Stevens, Architect. 

fleeted or obscured lights should be used, 
which give a soft glow over the whole 
room, with no bright spots. These ceiling 
lights can have lamps for greater or less 
illumination in the same fixtures ; and 
with the low candle power lamps used for 
night service, the lamps can be rendered 
less disturbing to the patient by dip- 
ping in blue stain. The fixture placed 
near the ceiling, with an opaque or opa- 
lescent reflecting globe placed below the 
light, directs all the rays to the ceiling, 
and thence diffuses them through the 
room. The bowl-shaped fixture should 
be covered with a tightly fitting sloping 
glass top to keep out the dust and to allow 
of its easy removal (Fig. 419). A most 
attractive fixture is made by having the 
lower globe double, and interposing 
fabric similar in coloring to the curtains 
and covering of furniture. 

In addition to the ward or room light- 
ing, there should be a wall outlet at each 
bed, where a portable table or wall lamp 
can be attached (Fig. 420). The wall 



outlet may be used also for an 
electric fan, electric heating 
pad, etc. 

The artificial illumination of 
operating rooms needs most 
careful study. Rooms have 
been successfully lighted by 
rows of lights around the out- 
er wall or on the ceiling near 
the wall; by a more concen- 
trated light in the center with 
a bowl-shaped reflector ; or by 
a fixture with several arms 
wide apart, so placed as to 
overcome shadows. A large 
fixture over the operating table 
is to be avoided on account of 
its tendency to catch and dis- 
tribute dust; and if a central 
light is used, the swinging 
crane is to be preferred. This 
can be raised or lowered, or 
swung entirely out of the way 
when not in use (Fig. 421). 

Concentrated light from 
powerful reflectors placed 
above the ceiling light gives 
very satisfactory results. (See 
Fig. 389.) 
Fig. 422 shows an operating light 
which is a combination of direct and re- 
flected rays. By placing these lights in at 
least four parts of the ceiling, one avoids 
having any fixture directly over the 
operating table, does away with the in- 
tense heat generated by high-power 
lamps, and practically eliminates shadows. 

It is well to provide gas for an emer- 
gency light in the operating room. The 
enclosed drop mantle burner is satis- 
factory for the purpose. Emergency 
lights have been successfully made by 
the use of the Prest-o-lite tank, mounted 
on a portable tripod and surmounted by 
a reflecting lamp (Fig. 136). 

A goodly supply of hand electric 
torches should be kept at the nurses' sta- 
tions against need. 

The Tungsten or Mazda lamp facili- 
tates illumination, giving the maximum 
amount of light with a minimum amount 
of current. 

For lights in the offices, kitchens, etc., 
nothing special is needed, except to se- 



OF THE TWENTIETH CENTURY 



335 



cure a fixture which has simple lines and 
from which all dust -catching ornamenta- 
tion is omitted and which will give 
proper illumination. 

The therapeutic effect of the color of 
zualls, ceilings, and finish is very marked 
upon patients. There is, perhaps, no one 
thing in the details of a hospital which 
should have more study than the wall 
and ceiling decoration or color, not only 
of the patients' rooms but also the en- 
trance, the reception rooms, the sitting 
room, and even the kitchens and work 
rooms. Why should the patient of re- 
fined taste, accustomed to harmonious 
colors in furniture and walls at home, 
be subjected to ugly, inartistic hospital 
rooms ? The walls should be of cheerful 
colors; the decorations, if any, should be 




























if 


































„ A, ....... 



*/e.cti°/s Fe°/it Ll-cvati°/i 




Plah Through ./helve/ 



ME. Dl CINE. CLOXT 

EDWAK.D r JTEVLNJ 
.'601TON IS«»S t5P4. 




FIG. 413. 



FIG. 414. MEDICINE CLOSET. 

refined. It is well to have diversity of 
coloring both in the walls and equipment. 
If the walls are painted a reasonably dark 
color to a height of five or six feet, and 
the ceiling color brought down to meet 
this line, divided by a band or simple 
stencil design, the effect is very satisfac- 
tory. If the color design is carried 
around the door and window frames, 
making an artistic flat decoration, so 
much the better. 

The introduction of tile and mosaic at 
the back of plumbing fixtures and radi- 
ators gives a touch of color and in ad- 
dition an element of cleanliness. (See 
Fie. 74.) 

The walls of the children's ward may 
be made most entertaining for the little 
folks by using simple decorations of 
"Mother Goose" or "farmyard" pictures, 
pasted on the walls in the form of a 
frieze and made permanent by a coat of 
varnish ; or prints of larger pictures may 
be fastened to the wall in the same way ; 
or, as mentioned in the chapter on chil- 
dren's hospitals, the walls may be deco- 
rated with Ceramic wall tile. 

The day of white walls for operating 
rooms or any other rooms, let us hope, 
is past. The walls of the operating room, 
if of tile or marble, should not be white 



336 



THE AMERICAN HOSPITAL 




FIG. 415. LINEN CLOSET DETAILS. 



but of some tone which will not absorb 
too much light but dark enough to pre- 
vent eye strain on the part of the sur- 
geon and attendants. If the walls are 
painted, the same argument will hold 
good. 

Many surgeons today wish the floors 
and lower portion of their operating 
room a very dark green, and use dark 
gowns for themselves and attendants, 
for the same reason — to prevent eye 
strain and to allow a better concentration 
on the subject to be operated upon. 

With reference to nurses calls, too 
much cannot be said in favor of doing 
away with the noisy system of electric 
bells. There are many systems of the so- 
called "silent call" on the market. All of 
them have merit. There are, however, 
essential points which should be con- 
sidered in selecting a system : 

1. The system should be simple 
and as nearly "fool-proof as pos- 
sible. 

2. The part made accessible to the 
patient should be of non-metallic sub- 
stance, with smooth lines, non-detach- 
able and easy to operate. 

3. The attachment to the wall 
should be of such a nature that if the 
connecting cable should be held by the 



bed-post and the bed suddenly moved, 
the entire system will not be disar- 
ranged; in other words, the "plug" to 
which the cord is attached should be 
readily removable, whether a straight 
or a side pull is exerted. This is a 
most important feature. 

4. The resetting station should be 
within easy reach of the patient's bed ; 
if on the wall, at such a height and 
location that the nurse can reset it 
without taking the time to go around 
the bed ; if at the press-button itself, 
which is in the patient's hand, so much 
the better; but if the point of resetting 
is at the patient's hand, there should 
be some locking device so that the 
patient cannot easilv cancel her own 
call. 

5. The signal lights, if in a ward, 
should be shown over each bed, also 
at the entrance of the ward, at the 
nurses' station and at the grand an- 
nunciator in the superintendent of 
nurses' office. Together with the last 
mentioned, an elapsed time record can 




FIG. 416. KITCHEN CABINET. 



OF THE TWENTIETH CENTURY 



337 



be kept, showing the time between any 
call and its cancellation. This is a de- 
vice which always settles a dispute as 
to whether a call remained unanswered 
one minute (as the record might 
show) or ten (as the patient might 
claim) . 



JTOJWD TO WAIL-^ 



ENAMELED MLTAL 




■5OTTUL UCY\ 




"I I 

v_ 

PLAN 

FIG. 417. NOSE AND THROAT DEPART 
MENT TREATMENT BOOTH. 




FIG. 418. DETAIL OF HOOK HANDLE FOR 
DOORS. 

A similar system may be installed for 
calling internes. The call is sent in from 
the main office and is flashed to different 
locations in the hospital. The interne, 
seeing his color or number illumined, 
calls the office from the nearest 'phone 
and gets his instructions. Signal lights 
for special calls, indicating special serv- 
ice, can also be arranged. 

The loud-speaking telephone, with a 




FIG. 419. DETAIL OF WARD LIGHTING 
FIXTURE. 



THK AM KR I CAN HOSPITAL 



338 




FIG. 420. PORTABLE BEDSIDE LAMP. 



sounder at convenient locations through- 
out the institutions, is now used to good 
advantage for calling superintendent or 
doctors. 

A telegraph key, with sounders at con- 




FIG. 421. ^OPERATING ROOM, QUINCY CITY 
HOSPITAL, SHOWING RADIATOR SHIELD 
AND CRANE LIGHT. 



venient points through the hospital, has 
been found a most effective calling de- 
vice. It offers little or no disturbance to 
the patients. 

Vacuum cleaners, it is the prevailing 
opinion, should be provided for every 
hospital of fifty beds or over, where 
power is available. The piping through 
the buildings can be very easily installed. 
There should be a sufficient number of 
outlets to make the work easy of accom- 
plishment by the attendants, no point in 
any room being more than fifty feet 
from an outlet. Each outlet should be 
valved, so that the applying of the hose 
can be done with as little noise as pos- 




FIG. 422. OPERATING 
LIGHT. 



sible. To that end, a special construc- 
tion is desirable, making it possible to 
enter the hose before opening the valve, 
thus eliminating much of the noise. 

There is some question about nurses' 
stations. Just where that of the head 
nurse of the floor or section should be is 
a question about which there is much 
discussion among hospital administra- 
tors — whether in a room adjoining the 
ward, in the open corridor, at a semi- 
glazed observation station, or in the 
ward proper. Dr. Rowe, the late dean of 
hospital superintendents, used to say 
that he believed the nurse on duty should 
be in sight of her patients as well as 
within hearing. In large wards the cen- 
ter-of-the-ward station may work out 
with the best results. 

AYherever this station may be, certain 



OF THE TWENTIETH CENTURY 



339 



conditions and equipment should exist. 
The nurse should have a table or desk, 
with sufficient light for her work of 
charting and keeping her records. She 
should have facilities for writing her 
records and holding them after they are 
written. At this point, the nurses' call 
system should have its annunciator. 

The writer believes that the charts, 
notes and standing orders for each 
patient should be kept together and that, 
as far as possible, those sheets should be 
of uniform size. 

The writer has found the most suit- 
able chart-holder to be made of heavy 
manilla paper, with the tops folded so 
as to enclose the top ends of all the pa- 
pers, all held in place by regular ring 
paper clips (Fig. 423). If the charts are 
to be hung, each chart is punched in the 
right spot for hanging; if placed on 
shelves, the punching is not necessary. 
These chart-holders are light, serviceable, 
and noiseless. A nurse, in going through 
the wards with the doctor, can take in her 
hands the charts for the whole ward, 
having them ready as the patient is ap- 



FIG. 423. PAPER CHART HOLDER AND 
CHART. 




FIG. 452. REVOLVING CHART CASE. 



proached. In this way they are always 
kept away from the patient, whereas if 
the chart is left on the bed it is available 
to the inquiring mind of the visitor and 
of the patient himself. 

Various methods for holding the charts 
in readiness for inspection are employed 
— one, the chart-case opening like a book 
with one cover against the wall, which, 
when open, discloses all the charts to 
view at one time (Fig. 424) ; another, 
the desk with "pigeonholes" for each 
chart-holder; a third, adopted by the 





FIG. 426. PLAN OF NURSES' STATION. 




340 



THE AMERICAN HOSPITAL 



writer for use where there are a large 
number on one service, built on the prin- 
ciple of revolving- book-case, with the 
center of the case placed on a level with 
the nurse's desk, so that without rising 
the nurse can reach any chart (Fig. 425). 

Where a room for the nurses can be 
provided, this should be central. The 



station shown (Fig. 426) illustrates an 
ideal nurse's station, for from this sta- 
tion the nurse controls not only the cor- 
ridor, but the stair hall, the elevator, the 
patients' airing balcony and the serving 
kitchen entrance ; with the use of the 
telephone, she is in touch with all de- 
partments. 





FIG. 424. WALL CHART 
CASE. 



OF THE TWENTIETH CENTURY 341 



equipment 



CHAPTER XVIII. 



The question of hospital equipment is 
fraught with nearly as many perplexities 
as the planning of the buildings. The 
question of the best bed, the best food 
wagon, the best operating table, or the 
best wheel stretcher is constantly met. 
There seems to be no general rule which 
will apply except this, that the simpler 
the lines of the apparatus or article which 
will accomplish the purpose with the 
greater conservation of energy of those 
using it, the better the equipment. 

The ordinary dealer in hospital equip- 
ment tries to sell the wares which he has 
in stock, and is not anxious to have 
special designs ordered ; but many times, 
in order to get the best results, it is neces- 
sary to have equipment specially made. 
It is true that the greater part of the 
equipment can be standardized, but it is 
equally true that much improvement re- 
mains to be made in some of the present 
standards. 

Discussion of equipment may properly 
consider first the furniture of the patient's 
own room, beginning with the bed. 
This must first of all be comfortable 
for the patient ; it must be of the right 
height to make work easy for the nurse ; 
it should have extension legs to allow of 
being raised at either end without blocks ; 
it must be easy to 
move, yet station- 
ary when required ; 
it should have an 
adjustable back 
rest, a bar at the 
foot to take care of 
the extension in leg 
fractures, a detach- 
able irrigator staff, 
and crosswise bars 
at the head where- 
by the patient may 
lift himself or get 
mild exercise. Full 
Gatch or Fowler 
position frames, 
built into the bed. 




FIG. 427. BODY REST FOR FOWLER 
POSITION. 



can be used to great advantage (Fig. 427). 
Care should be taken that the construc- 
tion of the frame is such that no project- 
ing braces nor lies will interfere with the 
comfort of the patient. 

To facilitate moving the bed, various 
forms of bed trucks are in use; that de- 
signed by Dr. Mackintosh of the West- 
ern Infirmary, Glasgow (Fig 427A), pro- 
vides for a fixed foot, with large casters 
on the head end ; when the patient is to 
be moved, the nurse or orderly throws a 
lever at the foot of the bed, forcing down 
a fifth leg with large caster, thus raising 
the foot of the bed from the floor. This 
leaves the bed on three large casters, 
ready to be moved with the slightest 
effort. A similar bed is now manufac- 
tured by American makers (Fig. 428). 
The single staff bed truck, used in a 
similar way, is quite effective (Fig. 429) . 

A fracture bed having a certain 
amount of resilience is now made with 
steel slats or carriage springs. The most 
popular is the open pattern, which is 
easily cleaned and adjusted. 

The two-piece maternity bed, which 
allows for the removal of the foot half 
and adjustment of the stirrups, is gen- 
erally coming into service in maternity 
hospitals. The illustration (Fig. 430) is 
that of a bed found 
by the writer in 
Berlin in 19 13. 
American m a n u - 
facturers, however, 
have improved on 
this in many details 
(Fig. 431).' 

The bedside table 
is perhaps the next 
in importance in 
the patient's outfit ; 
for, in the ward, it 
contains prized pos- 
sessions, and is sub- 
ject to many uses. 
Its contents should 
not be subjected to 



342 



THE AMERICAN HOSPITAL 



the gaze of the occupant of the next bed ; 
at the same time it should be open enough 
for good ventilation. It should be ad- 
justable so as to serve for an "invalid" 
or over-the-bed table (Fig. 432) ; an- 
other type shown (Fig. 434) fastens di- 
rectly to the bed and requires no floor 
space. For private rooms not connected 
with private baths, the utilities such as 
bed-pan, bowl, pitcher, etc., may be ar- 
ranged on the doors of a bedside cabi- 
net and so kept out of sight. 

In the private rooms the furniture 
should be refined and simple in lines, 
open underneath to facilitate cleaning. 
Plate glass tops placed over scarves of 
the same material as furniture covering 
or curtains help to bring the room into 
harmony. Chairs, of course, should be 
comfortable ; if upholstered, they should 
have removable covers. 

Footstools are always desirable. Those 
made similar to the Pullman car porters' 
stools have the advantage of stability 
(Fig. 435). 

For mattresses, nothing has been 
found more comfortable than a good 
quality hair. Both hair and feather pil- 
lows should be provided; and the small 
''comfort" pillow or bolster, about five 
inches in diameter and eighteen inches 
long, often eases the aching back or re- 
lieves the pain of a fractured limb and 
is also of great service in the maternity 
department. 

There might be added to the private 
room a good picture or two. Hung with 
a short cord directly from the back, they 
are easily taken down for cleaning. 

A rug, preferably washable, may be 
added with good effect. 

The hangings for the windows also 
should be washable. 

Care of patients' clothing might well 
be discussed here. In some hospitals the 
clothing of the ward patients is carefully 
put into individual lockers and the keys 
turned over to the patient, although he 
himself never sees the lockers; in others, 
"pigeonholes" or small bins are pro- 
vided for each ; and in still others, the 
clothing of one patient is hung side by 
side with that of others in a clothing 
room. 

The method adapted by the writer 



from the system used in the Munich- 
Schwabing Hospital (Fig. 436) is that 
of cloth lockers or bags of sufficient size 
to hold the clothing without folding. The 
bag is oblong, about eight by sixteen by 
fifty inches high, and is held in place by 
wire grilles at top and bottom ; from the 
top grille a hook extends through the 
top of the bag and serves to hang the 
bag to the pipe rack erected for the pur- 
pose ; from the top grille is suspended a 
garment hanger, with additional hooks 
for small garments. The bottom grille 
serves to hold shoes and small articles. 
The clothing can be placed in this bag by 




FIG. 427A. MACKINTOSH BED ADJUSTER. 

the patient, in the admitting room, and 
taken to the clothing room on a truck pro- 
vided for the purpose (Fig. 437). 

Great care should be taken in equip- 
ping the operating department. 

Sterilizers for hospital uses have, to a 
certain extent, become standardized and 
are manufactured by numerous special- 
ists in that line. The selection of the 
best is oftentimes a matter of personal 
judgment, but as with other hospital 
utilities there are certain underlying 
principles involved, whoever makes the 
apparatus. 

In the dressing sterilizer one should 
be able to sterilize all dressings, sponges, 
and other goods needed in the opera- 
tions, and have the same dry, ready for 
use. To do this, a steam pressure of 
about fifteen pounds, for a sufficient 
length of time, or super-heated air. or 



OF THE TWENTIETH CENTURY 



343 



both, is necessary. The size of the ap- 
paratus depends on the needs of the in- 
stitution. In America the most common 
forms are the horizontal, cylindrical and 
the globular ; while in European hos- 
pitals the vertical cylindrical type or the 
cabinet form is used. A shape which 
admits of baskets or semi-closed boxes 
facilitates handling the dressings. The 
box sterilizer shown in Figs. 438 and 
439, recently erected in the Royal Vic- 
toria Hospital, has some advantages over 
those of the same type found in Europe 
— principally in that the air is super- 
heated and steam, at a less pressure than 
formerly, is introduced. The bacterio- 
logical tests, however, show absolute 
sterility. 

The sterilizers for basins should be 
of sufficient size to hold what will be 
needed in an operation and should have 



an automatic lift both for cover and 
tray, either foot power or hydraulic. 

For instruments, gloves, etc., smaller 
sterilizers may be used, but the same 
principles should prevail as in the larger. 

A tank for saline solution, with ther- 
mostatic control, is a desirable addition. 

The sterile water to be used in dress- 
ing, in irrigation, or for cleaning the 
hands during operation, must be most 
carefully prepared. 

]!acteriologists assert that all of the 
harmful life is not destroyed at one boil- 
ing; but that to obtain absolute sterility, 
the process must be continued for three 
consecutive days, and even then, with 
careful filtration, minerals and solids are 
not removed. If they are right, safety to 
the patient will not permit the use of any- 
thing but distilled water for operation 
purposes. The water stills have become 





FIG. 428. FIXED BED TRUCK. 



344 



THE AMERICAN HOSPITAL 



standardized to such an extent that stills 
of almost any size can be procured in the 
market. 

If sterile water is needed in a number 




s : A 



J 



of different parts of the institution, it is 
more advantageous to place the water 
still and receiver in an elevated position, 
conducting the distilled water by gravity 
through tin-lined pipe to the various 
points needed, where a local instantane- 
ous heater can be located, with steam or 
electric heating unit. Water from the 
same still, through a separate storage 
tank, can be used for drinking purposes 
for the institution, as in the Royal Vic- 




FIG. 429. 



PORTABLE ONE-PIECE BED TRUCK 
AND IRRIGATOR STAFF. 



FIG. 430. TWO-PART MATERNITY BED, 
EUROPEAN MAKE. 




FIG. 431. TWO-PART MATERNITY BED, AMERICAN MANUFACTURE. 



OF THE TWENTIETH CENTURY 



345 




FIG. 432. ADJUSTABLE BEDSIDE TABLE. 

toria and the Ohio Valley General Hos- 
pitals. 

It often happens in small hospitals 
that no high pressure steam or gas is 
available for heating sterilizers. Elec- 
tricity or even kerosene oil can be used. 

The equipment for the operating 




FIG. 434. PORTABLE BEDSIDE TABLE, 
ATTACHED TO SIDE OF BED. 




FIG. 433. ADJUSTABLE BEDSIDE TABLE, WITH 
TOP EXTENDED OVER BED. 



rooms should be governed by the needs 
of the surgeons. A table with the num- 
erous necessary adjustments, instrument 
and utensil tables, stools for both sur- 
geon and anaesthetizer, and receptacles 
for soiled dressings are among the neces- 
sary items. If the room is fitted for com- 
pressed air, nitrous oxide gas, oxygen, 
and steam, the work of the surgeon is 
facilitated. 

Cabinets for dressings, instruments, 
and blanket warming, either built-in (as 
in Fig. 133) or portable, are necessary 
in the operating equipment. 

The newer type of alcohol dispensers, 
where only so much liquid as is needed 




FIG. 435. PATIENT'S FOOTSTOOL. 



346 



THE AMERICAN HOSPITAL 




FIG. 436. CLOTH LOCKERS FOR PATIENTS' CLOTHING. 



is released by foot pedal action, is con- 
sidered an economy, and in using this no 
two persons immerse their hands in the 
same fluid (Fig. 134). 

Demand for a room where the dirty 
work of the ward unit can be done has 
developed what is commonly termed a 
sink-room or work room. In the older 
hospitals one will find no such room, and 
the work now being done in this room 
was usually done in the toilet room, with 
the bed-pans and urinals placed on the 



walls or wherever there were a few 
square inches of space. The need of 
such a room is great. Here not only are 
the bed-pans discharged, washed and 
sterilized, but there should be a place for 
the preservation of specimens in a cool, 
ventilated space, opportunity for the 
boiling of catheters, making of poultices, 
etc. 

There should be a local incinerator in 
this room for the destruction of all ward 
waste, faded flowers, etc. (Fig. 441). 




ELEVATION Or 6 AC* 
CuOTttlMQ llOOM. 



tLtVATIOM/ Of TlUCK. 



<=r=r=5> 



DETAIL/ or 6ag 



-Plan or Huck 



Plan or- Iack 



ho/ntal- Clothing - P-cclptacll/ 

tDWAlD F /TtVER/ ~ ARCHITECT 
BO/TOr4~MA// 



FIG. 437. 



OF THE TWENTIETH CENTURY 



347 




FIG. 438. BOX STERILIZERS, BUILT INTO 
WALL. OPEN. 



There should be a sink for the washing 
of rubber sheets and utensils, and an ice- 
box for crushed ice ; in short, this should 
be a room which can be the general 
workroom of the section. 




FIG. 440. SECTION OF SINK ROOM. 




FIG. 439. BOX STERILIZERS, BUILT INTO 
WALL. CLOSED. 



If there is no local laboratory, this 
room will often serve the purpose. 

The disinfecting room in the general 
hospital should have either a steam pres- 
sure disinfector or a hot-air and formal- 
dehyde disinfector, or both, and room 
for the storage of mattresses after disin- 
fection. 




FIG. 441. SECTION OF SINK ROOM, SHOWING 
STERILIZER AND INCINERATOR. 



348 



THE AMERICAN HOSPITAL 



CHAPTER XIX. 

Hanbgcape Architecture asi Applteb to Hospitals! 



There are greater possibilities for the 
care of the convalescent in suitably 
planned grounds around a hospital than 
within the walls ; and when locating the 
buildings for a suburban hospital espe- 
cial accessibility to the grounds should 
always be considered. 

Wherever one goes in any of the 
larger institutions of Europe, one will 
see the convalescent patients walking or 
being wheeled along the shady paths, sit- 
ting under special arbors or awnings, en- 
joying the green grass and the flowers, 
and chatting with one another. Com- 
fortable benches and easy seats, splash- 
ing fountains and simple forms of 
amusement, all add to the pleasure, and 
shorten the convalescence. Walks, with 
frequent benches for resting, should be 
provided. At the Yirchow Hospital 
(Fig. 5), several acres arc devoted to 
the park in addition to the well laid out 
and well equipped grounds of the hospi- 
tal. In this park the staff, the nurses, 
the male and female patients are allowed, 
but on different days ; so that it becomes 
a private park for the enjoyment of all. 
(See Fig. 442.) 

In selecting the site, not only the ex- 
posure and the protection from cold 
winds should be considered, but the 
views from the hospital, the possible 
vistas from the wards or balconies. If 
the outlook is depressing in one direction 
it should be screened by a slight change 
in the location or by planting out the 
view. 

The site selected may have most beau- 
tiful trees which the hospital authorities 
demur about having cut ; but if the build- 
ings cannot be placed to advantage with- 
out this cutting, then the test applied by 
some landscape architects — "If the tret 
were out of the way, would you wish one 
in that place?" — is a verv good one to 
apply. 

Runways of easy grade from the floor 



level to the ground are always desirable. 

The planting should be carefully 
planned under the direction of some 
landscape architect of ability, so that the 
trees, the shrubs, the grass and the flow- 
ers bear the right relation to one another 
and to the architecture of the building. 
Shade should be provided where shade is 
needed, and care exercised not to plant 
too near the building so as to cause too 
much shade ; shady walks are desirable, 
but shaded buildings never, for with the 
shade comes dampness and chill, there- 
fore sunlight should reach the buildings 
wherever possible. 

The tendency of many landscape ar- 
chitects to mass shrubbery against a 
building, leaving the buildings as a back- 
ground, while it may enhance the beauty 
of the architecture or sometimes hide it, 
is very apt to shade a portion of the 
building which needs the sunlight. It is 
as true in landscape planning as in build- 
ing planning that the patient must be 
considered, and the therapeutic and heal- 
ing benefits of the sun's direct rays must 
outweigh the architecture ; for, as was 
said in another chapter, the hospital is 
built for the patient and not for the glori- 
fication of the architect or his running 
mate, the landscape architect. 

In the laying out of the patients' lawn 
or patients' court, the planting should be 
so arranged as to act as a screen from 
the public, as shelters to benches, and as 
shields against the prevailing cold winds. 

Fountains and pools, a rustic bridge 
and acquatic plants, if space and facility 
admit, and plenty of green grass add 
materially to the interest. If there are 
grades, these grades should be gentle, 
for the convalescent must be encouraged. 
All these things help the patients who 
are just recovering from an operation or 
convalescing from a fever to enjoy God's 
great out-of-doors. 

Just a few examples by way of show- 




FIG. 444. NEWTON HOSPITAL, NEWTON, MASS. ENTRANCE TO GROUNDS. 




FIG. 446. NEWTON HOSPITAL, NEWTON, MASS. GROUP VIEW. 
Kendall, Taylor & Stevens, Architects. 



352 



THE AMERICAN HOSPITAL 




FIG. 448. NEWTON HOSPITAL, NEWTON, MASS. VIEW IN GROUNDS. 
Herbert J. Kellaway, Landscape Architect. 




FIG. 450. NEWTON HOSPITAL, NEWTON, MASS. GROUP VIEW. 
Kendall, Taylor & Stevens, Architects. 



THE AMERICAN HOSPITAL 




FIG. 451. 



OF THE TWENTIETH CENTURY 



355 




FIG. 453. HEYWOOD MEMORIAL HOSPITAL, GARDNER, MASS. 
Kendall, Taylor & Stevens, Architects. 
Herbert J. Kellaway, Landscape Architect. 



356 



THE AMERICAN HOSPITAL 




FIG. 454. 



OF THE TWENTIETH CENTURY 



357 




FIG. 455. AN OLD PEOPLE'S HOME. VIEW 
IN GROUNDS. 



ing how some institutions have cared for 
the artistic effect as well as for the com- 
fort of the patient : 

In the general plan for the Newton 
Hospital (Figs. 443-450) will be seen a 
development extending over a score of 
years. When expansion was necessary 
more land was acquired, buildings altered 
and moved, and the scope of the plant 
increased. The whole group was brought 
into greater harmony by a careful study 
of the landscape possibilities, which were 
carried out under the able direction of 
Mr. Herbert J. Kellaway. Roads were 
changed, walks created, objectionable 
views planted out, tennis courts built, 
and the whole brought into harmony. 

In the Talitha Cumi Maternity Home 
(Fig. 451) the careful study of the pos- 
sibilities of the best location with the 
landscape architect before planning the 
buildings led the architect to take advan- 
tage of the natural beauty of the rather 
restricted site. 

At the Beverly Hospital (Fig. 452) 
at Beverly, Mass., and the Henry Hey- 
wood Memorial Hospital (Fig. 453) at 
Gardner, Mass., the problems were simi- 
lar. Steep grades were encountered and 
easy approaches considered, all to give 
not only a comfortable and dignified ap- 
proach, but one which would show the 
buildings to the best advantage and at 




FIG. 456. PORTABLE SEAT, WITH AWNING. 



the same time screen the patients from 
the view of approaching carriages. Study 
was made of the approach of service 
drives to kitchen and morgue. 

The site selected for the little hospital 
at Ipswich, the Benjamin Stickney Cable 
Memorial Hospital (Fig. 454), was in 
the beginning a barren field ; and the 
problem given to the landscape architect 
was to re-create the site by planting trees 
and shrubs, to make an easy approach 
to both front and ambulance entrances, 
to make an approach from the street car 
line to the building, and at the same 
time to screen all of these approaches. 
The high wall of the patients' court and 
the location of the airing balconies made 
this possible. This patients' court has 
private walks and pavilions and seats for 
the convalescents. 

With the city hospital on restricted 
land, small opportunity may exist, but 
what little there is to be done should be 
considered wisely. One rarely sees a 
more charming approach to a city hos- 
pital than that to the Phipps Psycho- 
pathic Clinic at the Johns Hopkins 
Hospital. 

If the architects can make the ap- 
proach to their hospitals speak the wel- 
come that they try to express in the 
entrance to the buildings, they will go a 
long way toward expelling the fear of 
entering an institution. 



358 



THE AMERICAN HOSPITAL 



CHAPTER XX. 



HemobeUng a J^ousie for a Jlosipttal 



The larger and more symmetrical the 
house, the better the hospital it will 
make. Not every house will deve'op 
into a good hospital, however, for there 
are many essentials required by the hos- 
pital which are not required in the house. 
The house, if it is to be used as a gen- 
eral surgical and medical hospital, must 
have a room which can be adapted into 
a well-lighted operating room with its 
adjacent utilities; also rooms of sufficient 
size to accommodate a reasonable num- 
ber of beds ; and rooms for the cooking 
and serving of meals. When a house of 
this character can be found, then it is 
practicable to utilize it for a hospital, 
with proper care of details. 

The selection of the house to be used 
must have the same care as trie selection 
of a site for a new hospital ; that is, there 
must be sufficient light and air about the 
building to insure good ventilation ; there 
must be freedom from disturbance from 
adjoining property, and, if possible, a 
pleasing view from the building. Care 
should be taken to select a house where 
the sunshine penetrates the principal 
rooms. 



The transformation of a house into a 
hospital, illustrating this paper, was 
made at two different periods — in 1909 
when the old Choate homestead at Wo- 
burn was given to the Woburn Charit- 
able Society, and again in 1916 when 
that institution, growing from the small 
beginning, was developed into a hos- 
pital of moderate proportions and 
capable of still further increase. 

In the first development it will be seen 
how. with very modest changes, a fairly 
workable hospital was evolved. The ex- 
terior was of the type one often encount- 
ers in New England especially, built in 
the sixties, with great double parlors, 
heavy cornices and finish, stately dining 
room and serving pantry, and basement 
kitchen. All of this, however, lent itself 
to "hospital treatment," as will be seen 
by comparing the plans of the original 
house with those of the replanned hos- 
pital. The funds available for alterations 
were small and the changes necessarily 
restricted. 

The grand parlor made an excellent 
five-bed ward without change, while the 
sitting room served as a children's ward. 




FIG. 457. FIRST FLOOR BEFORE FIG. 458. SECOND FLOOR OF THE 

MODIFICATION. CHOATE HOMESTEAD. 



OF THE TWENTIETH CENTURY 



359 




FIG. 459. THE CHARLES CHOATE MEMORIAL HOSPITAL 
AS PRODUCED BY THE FIRST MODIFICATION 
OF THE CHOATE HOMESTEAD. 
Edward F. Stevens, Architect. 



and the little den as the hospital office. 
The circular stairs had to go, and were 
replaced by more commodious stairs, up 
which the stretcher could be carried. The 
dining room was cut into a corridor, a 
serving kitchen, and a linen closet. The 
garden porch served as an airing bal- 
cony. 

The second story also developed simply 
and inexpensively. A good operating 



room and accessories were made 
from one of the large chambers, 
while another served as a second- 
story serving room. The balcony 
was extended to this story. 

The changes in the basement 
were small. The kitchen needed 
no change ; the old laundry served 
nicely for a nurses' dining room; 
in the attic, the servants' rooms 
were used for nurses. Thus the 
Charles Choate Memorial Hospi- 
tal started out as a complete four- 
teen-bed institution. 

During the eight years of suc- 
cessful management after the 
opening, friends of the hospital, 
seeing the splendid work being 
accomplished with the simple 
equipment, came to the rescue 
with bequests and generous dona- 
tions, so that in 1916 the much- 
needed expansion was authorized. 

To plan for the growing needs of the 
present and the future and to preserve 
and bring into harmony as much of the 
old building as possible with the new 
was the problem now to be worked out. 
The greatest needs were, first, better 
operating facilities ; second, more private 
rooms ; and third, a maternity depart- 
ment worthy of the name. 




FIG. 460. BASEMENT FLOOR AS FIRST 
REMODELED. 

The laundry has been made into a nurses' dining 
room. Otherwise there is little change. 




FIG. 461. FIRST FLOOR AFTER FIRST 
REMODELING. 

The parlor and sitting room have been transferred 
into wards. The den has been made into an office. 
The circular stairway has been removed. 

Edward F. Stevens, Architect. 



360 



THE AMERICAN HOSPITAL 



the deficiency of the old building and the 
growing needs of the community. A new 
main entrance and office, are created, and 
a new operating department is provided. 

The operating department consists of 
two north-lighted operating rooms, a 
sterilizing room, an anesthetizing room, 
a nurses* work room, and a surgeons' 
locker and dressing room. All these 
rooms are grouped around an octagonal 
rotunda, in the center of which is a 
triple scrub-up fountain, designed not 
only as a necessary utility, but also as an 
architectural feature of the department. 
(Fig. 401.) The base of the fountain is of 
mosaic; the bowl is porcelain enameled, 
40 inches in diameter ; the water is con- 
trolled by the latest type of elbow valves ; 
and the whole is surmounted by a utility 
shelf of opal glass. The large size of the 
rotunda leaves ample room on all sides 
for the wheel stretcher to pass. The floor 
of this department is of terrazzo and the 
walls are enameled, hard plaster. Large 
north windows, extending above the ceil- 
ing, give the best of daylight, while four 
special artificial lights illuminate the 
operating rooms at night. 

The ambulance entrance is below the 
surgical department and adjoins the 
laboratory, the X-ray, and the autopsy 
rooms. A small isolating suite, with 
special plumbing, is provided, as well as 
drug and storage rooms. 

In the basement of the medical wing 




FIG. 463. THE CHOATE HOSPITAL AS IT APPEARS AFTER ADDITIONS AND 
FINAL REMODELING. 
Edward F. Stevens, Architect. 




FIG. 462. SECOND FLOOR AFTER FIRST 



One large bedroom has been transformed into an 
operating room, and another into a diet kitchsn. 
The other bedrooms have become wards and super- 
intendent's room, respectively. 

Edward F. Stevens, Architect. 

But few changes were necessary in the 
original building, as will be noted on 
plans (Figs. 459-463). The kitchen was 
enlarged ; the old nurses' dining room 
was made into cold storage and a serving 
room for the new dining room ; the stairs 
were removed and the serving kitchens 
enlarged; the old operating suite was 
turned into a maternity delivery room 
and bath room, and one of the private 
rooms taken as a creche. 

The new portions are planned to meet 



362 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 



363 




OF THE TWENTIETH CENTURY 



365 



are located the nurses' dining room, the 
lecture and ladies' aid rooms. An auto- 
matic electric elevator connects all stories. 
The first story of the medical and the sec- 
ond story of both the surgical and medical 
wings are planned for private patients, 
mostly single rooms being planned. At 
the south end of the building airing bal- 
conies are provided. 

Sink rooms, toilets, baths, and linen 
rooms are arranged for the efficient car- 
rying out of modern hospital service. 



The floors of all wards, rooms, and cor- 
ridors are covered with linoleum ; the 
doors are without panels ; and all detail 
of finish is of plain, simple construction. 

For the mechanical plant, the old 
stable was utilized, affording plenty of 
room for the heating and laundry equip- 
ment. 

These remodeled buildings, with the 
nurses' residence (also a donation) on the 
same site, make a complete thirty-three- 
bed hospital. 



366 



THE AMERICAN HOSPITAL 



APPENDIX. 

»ar hospitals 

Development of the Hospital Ward Unit of the United States Army 



When the United States entered the 
world ward in 1917, there existed few, 
if any, large army hospital units in this 
country, and the few which existed had 
not received the careful study and plan- 
ning accorded the civilian hospitals and 
were hardly comparable with the army 
hospitals of other nations. 

When the government established the 
sixteen cantonments and the sixteen Na- 
tional Guard camps, hospitals for the ac- 
commodation of approximately one 
thousand beds each were designed by the 
army officers in charge of this work at the 
Surgeon-General's office. These groups 
originally comprised from sixty to 
seventy buildings, but this number was 
greatly augmented later by the addition 
of convalescent units. 

In this discussion, the general group- 
ing and the portion occupied by the sick 
soldiers — the ward unit — will be con- 
sidered ; the mechanical plant, the oper- 
ating unit, and the housing for staff and 
orderlies will not be taken up. 

It should be remembered that at the 
time the United States entered the war 
the French had more than six hundred 
thousand and the British nearly one mil- 
lion beds in army hospitals, from which 
it was possible to find precedents as to the 
plan best adapted to the needs of the 
United States. In the French army hos- 
pitals, in particular, there had been de- 
veloped an economical and practical solu- 
tion of the ward unit, at least. 

These United States hospital buildings 
just referred to, like the cantonment bar- 
racks, were built of wood, with wooden 
foundations, and in a temporary man- 
ner. With but few exceptions the build- 
ings were only one story in height and in 
almost every case were connected with 
each other and with the other units by 
covered corridors. 

The ward unit plans, as first presented 
by the Surgeon-General's office, contem- 



plated the grouping of the ward buildings 
in pairs, with the toilets placed between 
the wards at one end and joined with con- 
necting corridors between the buildings 
at the other end, as shown in Figure 1. 
Before the plans were issued for erection, 
it was realized that enclosing the space 
between the wards not only cut out light 
and air, but afforded an extra fire menace 
and inaccessible pocket, and this plan was 
abandoned. In some of the wards, hovv 
ever, this form of between-ward toilet 
was used at the corridor end, but for the 
greater part the single ward unit was 
adopted (Fig. 2). 

This plan provided for thirty-two 
patients in one ward and a quiet room 
for two patients, with diet kitchen, 
office, toilet, linen room, etc. Each ward 
had eighteen windows, a total of 278 
square feet, or 12.3 per cent, of the wall 
surface. A 12-foot balcony extended 
along one side, a feature which was a 
decided advantage in the southern cli- 
mate and for treating certain diseases, 
but which greatly reduced the air and 
sunlight for the ward itself. 

As a very large proportion of army 
hospital patients are ambulatory, it was 
found to be economy to build additional 
two-story wards for these men, as well 
as for convalescents. Each of these 
units consisted of four wards or dormi- 
tories, two day rooms, toilets, and bal- 
conies, but contained no provision for 
the service of food. 

While the orienting of the wards on 
the site is almost as important as the 
plan, the general thought of the officer 
in charge of the planning of the hos- 
pitals was that "the hospital must face 
the cantonment," and the question of 
sunlight and air was largely disregarded. 
One noteworthy example, however, was 
at Camp McClellan, Anniston, Ala., 
where the grouping and orientation were 
vastly improved. (See Fig. 3.) True 



OF THE TWENTIETH CENTURY 



367 




Courtesy "The Modern Hospital" 

Fig. 1. Plan for Base and Cantonment Hospital, as first presented by the Surgeon-General's Office 

(May, 1917). 



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Courtesy "The Modern Hospital" 

Fig. 2. Plan for Base Hospital Unit (Sugeon-GeneraPs Office, August, 1917). 



368 



THE AMERICAN HOSPITAL 




OF THE TWENTIETH CENTURY 




370 



THE AMERICAN HOSPITAL 



ii was with the general plan (Fig. 1 ) that 
in whichever directions the hospital 
faced, 50 per cent, of the ward would re- 
ceive the maximum amount of sunlight 
and air, at the expense of the other 50 
per cent. Of course, it was necessary 
in the thirty to forty groups to erect the 
buildings on the sites selected, and it is 
to be surmised that few "faced the can- 
tonments." 

The planning of our overseas hospital 
units then followed, and these plans 
were developed under the direction of 
the Chief of Engineers, U. S. A. A new 
general plan was adopted, so arranged 
that the maximum amount of sunlight 
and air would be obtained for all wards 
or patients' buildings (Fig. 4) and that 
the administrative portion would be cen- 
tralized. 1 

As the overseas hospitals were de- 
signed to be fabricated at a distance and 
shipped ready to erect, the buildings 
were confined to certain standard widths. 
The ward unit, however (Fig. 5), was 
designed to obtain the maximum 
amount of light and air for the patient. 

A standard of thirty-two beds was 
provided, and the general utilities were 
made similar to the plans made by the 
Surgeon-General's office, but the method 
of lighting and ventilating was improved 
by increased window sizes, so that 24.5 
per cent, of the wall surface was glass 
and capable of being opened 100 per 
cent, of the glass area. The airing bal- 
cony was placed at the south end, leav- 
ing the sides free for light and air. 
These wards were to run approximately 
north-south, with the airing balcony at 
the south, leaving a space between 
buildings of 33 feet. 

Removable panels forming ramps gave 
extra provision for emergency exits, by 
which the patients could be speedily re- 
moved. 

Double floors, walls, and roofs insured 
protection from heat and cold. 

While many slight changes were made 
in the Surgeon-General's ward unit run- 
ning from K-l to K-30, the same gen- 

1. The planning of these units was placed in the 
hands of Mr. Charles Butler, who had served the 
French Government in constructing army hospitals, 
and of the writer. 




372 



THE AMERICAN HOSPITAL 



era] scheme prevailed for the army hos- 
pitals in this country, until the so-called 
'"head-house" type of hospital was de- 
veloped. This was brought about by the 
desire for a more concentrated plan, one 
covering less area and consequently 
easier of administration, and allowing 
for greatly increased capacity. 

This general plan (Fig. 6) called for 
buildings practically all to be two stories 
in height, the ward buildings being pa- 
vilions joined to the head-house. Each 
ward unit consisted of two 100-bed 
wards, twenty single or quiet rooms, 
toilets, diet kitchens, etc. (Fig. 7.) The 
wards are 11 feet in the clear height, 48 
feet wide, with beds arranged in four 
files. There are twenty-six double win- 
dows on each side, taking up 23 per cent, 
of wall area. The heads of the windows 
were placed 2 feet 5 inches from the 
ceiling to the sash, and the cubical con- 
tents were minimized by using a flat in- 
stead of a sloped ceiling for the second 
story. The light is reduced by a wide 
side airing balcony and by ramps on the 
opposite side from the balconies. A gal- 
lery connecting the pavilions on the 
south affords a means of escape in case 
of fire and a means for the ambulatory 
patients to reach mess in pleasant 
weather. The private or quiet rooms are 
placed on a corridor which is the main 
artery of communications and for sup- 
plies and which in some cases is over 
1,000 feet long, lighted by direct light 
only at the ends. 

The orientation generally is good, as 
all wards run north-south, but the prece- 
dent here established by the government 
of placing one hundred sick soldiers in 
one room or ward, with but 3 feet be- 
tween the beds and without subdivisions, 
is one which civilian hospitals would not 
dare to follow. 

That psychiatric ward unit, planned to 
occupy the same area and to be capable 
of conversion into a general ward, is 
shown here (Fig. 8). While the sub- 
divisions would seem well proportioned, 
the difficulty of administration is appar- 
ent from the fact that in passing from the 
main corridor to the south exit, one must 
pass through no less than eight doors, 



which must be unlocked and locked after 
every passage. This could have been 
avoided by a continuous corridor. 

In the isolation unit of the type (Fig. 
9), there would seem to be an insufficient 
number of isolation rooms, and the main 
toilet, having little use in this unit, would 
seem unnecessarily large. The wide air- 
ing balcony, too, could safely be used only 
by patients suffering from the same dis- 
ease. 

Numerous types of wards for the care 
of tuberculosis were developed, but only 
two are here described. One of these 
consisted of a double row of beds, facing 
an open south front ; another, built on 
the so-called "King plan," was known as 
the "shack" arrangement. While in the 
double plan the patient may be protected 
from his neighbor by the screens which 
are "staggered" to prevent one patient 
from being placed directly in front of 
another, the back row, nevertheless, 
would receive the minimum benefit of 
the "cure" because of the blocking up of 
light and air by the front row and the 
impracticability of moving the beds into 
the sun. In the shack plan, however, 
this objection does not occur, and the 
patient is protected from his neighbor 
by the screen and may have his bed 
moved into the sun at will. The day 
room and dressing-room are common to 
the two wards and are essential to the 
comfort and well-being of the patients. 

After this later head-house type of 
ward buildings were well under way and 
materials ordered, the Assistant Secretary 
of War in October appointed a commit- 
tee of three hospital architects 2 to review 
and offer constructive criticism of the 
existing and proposed hospital build- 
ings. After a careful study of all the 
plans for hospitals so far developed in 
the Surgeon-General's office and after 
a further study of existing buildings 
erected, in use, and in course of erec- 
tion, this committee realized that to pro- 
vide for large units of from one to 
two thousand patients, some form of 
two-story buildings must be used in 
order to economize both in ground area 

2. Consisting- of Mr. Charles Butler, Mr. L M 
Franklin (of York & Sawyer), and the writer. 



OF THE TWENTIETH CENTURY 



373 




THE AMERICAN HOSPITAL 




376 



THE AMERICAN HOSPITAL 




Courtesy "The Modern Hospital" 
Fisr 10 General Block Plan for a 2,000-bed Hospital. Proposed by Committee of three on Army Hospital 

Plans (November, 1918). 




Courtesy "The Modern Hospital" 

Fig. 11. New General Plan for Wards of Fifty Beds, divided into two-bed cubicles. 



378 



THE AMERICAN HOSPITAL 



and in cost of administration and at the 
same time to afford sufficient protection 
to the patient and prevent the spread of 
contagion. The general plan (Fig. 10) 
shows how the ward units attached to 
the general corridors are grouped around 
the central buildings. 

The new ward unit (Fig. 11) was de- 
signed, providing for fifty beds in each 
ward instead of one hundred. The util- 
ities were placed on the south of the 
through corridor, which is lighted abun- 
dantly on the north. The ward is 28 
feet wide, with one file of beds on either 
side of the center. The side is 27.6 per 
cent glass, which is capable of opening 
100 per cent for air; the windows, being 
carried to the ceiling, afford the max- 
imum ventilation. A low screen is placed 
between each two beds, protecting one 
patient from another. No sunlight is 
cut off on the east or west, but an ample 
balcony is provided on the south. A gal- 
lery connecting wards at the south end 
and ramps at either end of the group 
affords an exit in case of fire and a quick 
way to reach the mess hall. The quiet 
rooms are in an extension at the north 
of the connecting corridor, with east and 
west exposure. The corridor, amply 
lighted on the north, connects with all 
departments. 

Fireproof stairs at either end of the 
unit and the ramp at either end of the 
second-story gallery afford ample fire 
exits. 

In the psychiatric ward recommended 
by the committee (Fig. 12), provision 
was made for subdivisions similar to 
those adopted in the wards designed by 
the Surgeon-General's office, but with 
ready access to one section from another, 
and with the ward divided for disturbed 
and semi-disturbed patients, with a sep< 
arate day room for each. In the dis- 
turbed portion, four quiet rooms for the 
violent patients were provided, together 
with two four-bed wards ; in the semi- 
disturbed section, two four-bed and two 
Three bed wards and two quiet rooms 
were planned. 

The unit is so arranged that in passing 
from the diet kitchen to the extreme 
south end of the building, it is neces- 
sary to pass through but two doors, each 



ward being separated from the main cor- 
ridor. Ventilation is secured by making 
all the walls of the interior partitions but 
eight feet high; in the disturbed portion, 
the walls are continued by substantial 
grilles. Doors into the admitting and 
treatment department, the diet kitchen, 
the nurses' room, and the ward surgeon's 
room open from the main corridor. 

Provision is made for limited contin- 
uous bath, as from observation and con- 
sultation with the specialists it was found 
that one bath for each unit would be 
sufficient in the army hospitals. 

In the isolation plans submitted by the 
committee (Fig. 13), the principles of 
the Pasteur Hospital were recognized ; 
a large number of isolation cubicles were 
constructed, each cubicle provided with 
sink and watercloset. In four and six- 
bed wards, each two beds are separated 
from the others by a low screen to 
minimize the possibility of cross-in- 
fection. 

Narrow open galleries surrounding the 
building make observation and communi- 
cation with patients possible from out-of- 
doors, making practicable the visiting of 
friends with the minimum danger of con- 
tagion. Fireproof stairways connect the 
airing balconies, and the communication 
balconies are the same in the general 
ward plans. 

Another type of overseas ward unit 
built at Sarisbury, England, from plans 
of Arnold Thornley, F.R.I.B.A., for the 
American Red Cross and for our sick 
soldiers, presents some new thoughts in 
the bed arrangement, at least. 

This hospital, when completed, will 
accommodate two thousand beds. Each 
unit consists of four wards of seventy- 
eight beds each and a common bath and 
toilet "block." These toilet and bath 
blocks, located equidistant from the 
wards, will be an economy in construc- 
tion and cubing if they prove to give 
enough capacity for the needs. The 
wards are 40 feet wide, with high walls 
and a ceiling reaching to the roof line, 
which is crowned by a monitor. 

The bed arrangement is unique. Whilt 
there are four rows of beds, the two 
inner rows are kept away from each 
other by a 5-foot permanent screen run- 



380 



THE AMERICAN HOSPITAL 



ning down the center of the ward, really 
dividing the ward into two thirty-nine- 
bed units ; for supervision, however, the 
attendant standing at the end of the 
ward, obtains a complete view of the 
entire ward. 

As these wards are but one-story high 
with numerous exits, the lack of airing 
balconies may not be noticed. The win- 
dow spacing (every 6 feet with 3-foot 
windows) should give plenty of light 
if carried nearer the ceiling. 



The connecting corridors are ten feet 
wide. 

While the "double-ended" ward can 
obtain only the average amount of sun, 
there will be a maximum amount of sun 
on one side if it is oriented east and 
west. The lack of sufficient utilities and 
the absence of quiet rooms seems to be 
the greatest defect in this plan. 

These units are built of "cinder brick," 
a permanent form of construction, and 
present an attractive appearance. 



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AUG s Wft 



WX 140 S844a 1921 
53411000R 




NATIONAL LIBRARY OF MEDICINE